1205904919 NPI number — LIFETIME CARE AT HOME LLC

Table of content: MS. KATHLEEN ANNE KAISER LCSW (NPI 1659427185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205904919 NPI number — LIFETIME CARE AT HOME LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFETIME CARE AT HOME LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205904919
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
753 BOSTON POST RD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
GUILFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06437-2749
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-315-5286
Provider Business Mailing Address Fax Number:
203-458-5997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
753 BOSTON POST RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
GUILFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06437-2749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-315-5286
Provider Business Practice Location Address Fax Number:
203-458-5997
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MESSINA
Authorized Official First Name:
MARY
Authorized Official Middle Name:
GERETTE
Authorized Official Title or Position:
DIRECTOR, REGULATORY REIMBURSEMENT
Authorized Official Telephone Number:
203-688-8543

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004144060 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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