Provider Demographics
NPI:1982687943
Name:MIDSTATE VNA & HOSPICE
Entity Type:Organization
Organization Name:MIDSTATE VNA & HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MPH, CHCE
Authorized Official - Phone:203-235-5714
Mailing Address - Street 1:1 RESEARCH PKWY
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-8400
Mailing Address - Country:US
Mailing Address - Phone:203-235-5714
Mailing Address - Fax:
Practice Address - Street 1:1 RESEARCH PKWY
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-8400
Practice Address - Country:US
Practice Address - Phone:203-235-5714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC81751251E00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251E00000XAgenciesHome Health
Not Answered251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT185412OtherFIRST CHOICE HEALTH PLAN
CT0782132OtherAETNA
CTC81751OtherCIGNA
CT747022OtherCONNECTICARE
CT677HHOtherABCBS
COA789028OtherOXFORD HEALTH PLAN
CT=========OtherONE HEALTH PLAN
CO=========OtherUNITED HEALTH CARE
COA789028OtherOXFORD HEALTH PLAN
CT=========OtherCHNCT
CT=========OtherPIONEER HEALTH NETWORK
CT185412OtherFIRST CHOICE HEALTH PLAN
CT077045Medicare ID - Type UnspecifiedHOME HEALTH PROVIDER #