Prospect Waterbury Home Health, Inc.
Organization Active NPI Home Health Agency · Watertown, CT
NPI 1265880413 · NPPES record last updated Oct 14, 2022
Key facts
- NPI
- 1265880413
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- Legal business name
- PROSPECT WATERBURY HOME HEALTH, INC.
- Practice address
- 365 Main St Ste 3a
Watertown, CT 06795-2249 - Phone
- (860) 274-7531
- NPI assigned
- May 27, 2016
- Organization subpart
- No
Authorized official
- Name
- Robert Jon Elders
- Title
- Secretary
- Phone
- (714) 788-1249
Owners & managing parties with NPI records 1
Member of 1
Change of ownership 1
Facilities with the same owner 13
Affiliated clinicians 65
-
Florentino Abueg, MD
-
Carlos S Almeida, MD
-
Ehsan Ansari, M.D.
-
Ionut B Anton, MD
-
Paul J Beauvais, MD
-
Robert Kingsbury Botta, M.D.
-
Jolanta Brankiewicz, APRN
-
Victor Chang, MD
-
Seth Lynton Clohosey, M.D.
-
Elisha Danzig, DO
-
Joseph P Deluca, M.D.
-
David Forshaw, MD
-
Adriana S Ghisa, MD
-
Michael Harma, MD
-
Nieves Hornbeck, M.D.
Medicare Care Compare: Home health agency
- Listed as
- Uconn Health Community Network Home Health, Inc.
- Overall star rating
- ★★★★☆ 3.5 of 5
- Ownership
- Non-Profit
- Certified
- Jul 1, 1966
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Home health agency certification: CCN 077085
- Legal name
- PROSPECT WATERBURY HOME HEALTH INC
- Doing business as
- VNA HEALTH AT HOME INCORPORATED
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Jul 1, 1966
- Last certification
- Oct 23, 2018
- Ownership / control type
- Non-Profit
- Most recent change of ownership
- Mar 1, 2026
- Organization structure
- Corporation · Proprietary
- Incorporated
- Apr 8, 2016 in CT
- Enrollment address
- 365 Main St
Ste 3a
Watertown, CT 06795-2249
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Sang Bum Lee |
5% Or Greater Indirect Ownership Interest | Oct 1, 2016 | 66.67% |
| Corporate Officer |
Oct 1, 2016 | ||
| Robert Elders |
Corporate Officer |
Jun 15, 2020 | |
| W-2 Managing Employee | Jun 15, 2020 | ||
| Greg Williams |
Corporate Officer |
Jan 13, 2022 | |
| JP Morgan Chase, N.a. |
5% Or Greater Direct Ownership Interest | Oct 1, 2016 | |
| 5% Or Greater Security Interest | Jun 30, 2016 | 100% | |
| Eric Samuels |
Corporate Officer |
Jun 3, 2019 | |
| Ivy Intermediate Holding Inc |
5% Or Greater Indirect Ownership Interest | Oct 1, 2016 | 100% |
| Filomena Rinaldi |
Corporate Officer |
Nov 3, 2021 | |
| Alfredo Sabillo |
Corporate Officer |
Jul 21, 2020 | |
| Ivy Holdings Inc |
5% Or Greater Indirect Ownership Interest | Oct 1, 2016 | 100% |
| Prospect Waterbury Inc |
5% Or Greater Direct Ownership Interest | Oct 1, 2016 | |
| William M Gorenstein |
Corporate Officer |
Aug 15, 2016 | |
| Prospect CT Inc |
5% Or Greater Direct Ownership Interest | Oct 1, 2016 | |
| David & Alexa Topper Family Trust |
5% Or Greater Indirect Ownership Interest | Oct 1, 2016 | 33.33% |
| David R Topper |
Corporate Officer |
Oct 1, 2016 | |
| Other | Oct 1, 2016 | ||
| Chamber Inc |
5% Or Greater Indirect Ownership Interest | Jun 1, 2021 | 100% |
| Prospect Medical Holdings Inc |
5% Or Greater Indirect Ownership Interest | Oct 1, 2016 | 100% |
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Oct 1, 2016 | Change of Ownership |
Vna Health at Home |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160809003352 | CT | Part a Provider - Home Health Agency | 9133413446 | Practice locations: Watertown, CT |
National Provider Directory
Locations
27 Siemon Company Dr
Ste 101
Watertown, CT 06795
Phone (860) 274-7531
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Yes |
Addresses
Primary practice location
365 Main St Ste 3a
Watertown, CT 06795-2249
Mailing address
365 Main St Ste 3a
Watertown, CT 06795-2249
Phone (860) 274-7531
Other names
- VNA Health at Home
- VNA at Home
Other providers in Watertown, CT
- Proactive Approach ABA
- Professional Care at Home LLC
- Professional Care at Home LLC
- Project Interact, Inc
- Gerdt Propfe Jr.
- Quad ABA, LLC
- Heather Laura Quadrato
- Quality Visiting Nurses LLC
- Rachael Hannah Quicquaro
- Moqueet Arshad Qureshi
All providers in Watertown, CT · Home Health Agency in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.