Provider Demographics
NPI:1336178276
Name:STRATFORD VISITING NURSE ASSOCIATION, INC.
Entity Type:Organization
Organization Name:STRATFORD VISITING NURSE ASSOCIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:THERIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-375-5871
Mailing Address - Street 1:88 RYDERS LN
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-1666
Mailing Address - Country:US
Mailing Address - Phone:203-375-5871
Mailing Address - Fax:203-378-8193
Practice Address - Street 1:88 RYDERS LN
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-1666
Practice Address - Country:US
Practice Address - Phone:203-375-5871
Practice Address - Fax:203-378-8193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC81841251E00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT077001Medicare ID - Type Unspecified