Provider Demographics
NPI:1881689180
Name:BETHEL VISITING NURSE ASSOCIATION INC.
Entity type:Organization
Organization Name:BETHEL VISITING NURSE ASSOCIATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:L
Authorized Official - Last Name:MALIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:203-792-0864
Mailing Address - Street 1:70 STONY HILL RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-3036
Mailing Address - Country:US
Mailing Address - Phone:203-792-0864
Mailing Address - Fax:203-730-8053
Practice Address - Street 1:70 STONY HILL RD
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-3036
Practice Address - Country:US
Practice Address - Phone:203-792-0864
Practice Address - Fax:203-730-8053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC805410251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P09360OtherCOMMUNITY HEALTH PLAN
004042545OtherCT COMMUNITY CARE
653 BVOtherANTHEM BCBS
782135OtherAETNA
A785425OtherOXFORD HEALTH PLAN
CT004042545Medicaid
765195OtherCONNECTICARE
077113Medicare ID - Type Unspecified