Provider Demographics
NPI:1720731540
Name:PETRENKO, ELENA (MSHCA)
Entity Type:Individual
Prefix:MISS
First Name:ELENA
Middle Name:
Last Name:PETRENKO
Suffix:
Gender:F
Credentials:MSHCA
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:
Other - Last Name:PETRENKO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSHCA
Mailing Address - Street 1:PO BOX 985
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-7285
Mailing Address - Country:US
Mailing Address - Phone:203-680-9148
Mailing Address - Fax:
Practice Address - Street 1:96 COUNTY RD
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-1245
Practice Address - Country:US
Practice Address - Phone:203-680-9148
Practice Address - Fax:860-217-1507
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker
No385H00000XRespite Care FacilityRespite Care