1588383129 NPI number — RELIANT IN-HOME CARE AND COMMUNITY SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588383129 NPI number — RELIANT IN-HOME CARE AND COMMUNITY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RELIANT IN-HOME CARE AND COMMUNITY SERVICES
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:
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:
1588383129
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 FOX ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST SPRINGFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01089-2632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-274-9330
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
67 HUNT ST STE L101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AGAWAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01001-1920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-274-9330
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/25/2022

Additional Information

Authorized Official

Authorized Official Last Name:
AL MSHAKHEEL
Authorized Official First Name:
ALI
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
207-274-9330

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: NA . This is a "N/A" identifier . This identifiers is of the category "OTHER".




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