Provider Demographics
NPI:1356344956
Name:TOWN OF ORANGE
Entity type:Organization
Organization Name:TOWN OF ORANGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOSVA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:203-891-2165
Mailing Address - Street 1:605 A ORANGE CENTER ROAD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477
Mailing Address - Country:US
Mailing Address - Phone:203-891-4752
Mailing Address - Fax:203-891-2169
Practice Address - Street 1:605 A ORANGE CENTER ROAD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477
Practice Address - Country:US
Practice Address - Phone:203-891-4752
Practice Address - Fax:203-891-2169
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN OF ORANGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-27
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT251E00000X
CTC80247251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4043014Medicaid
CT004043014Medicaid
CT4043014Medicaid
CT07-7078Medicare UPIN