1184873424 NPI number — MERCY HOME CARE OF CONNECTICUT, INC.

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 1184873424 NPI number — MERCY HOME CARE OF CONNECTICUT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY HOME CARE OF CONNECTICUT, INC.
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:
1184873424
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28 KNIGHT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORWALK
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06851-4719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-852-0773
Provider Business Mailing Address Fax Number:
203-299-0415

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 LIBRARY PL
Provider Second Line Business Practice Location Address:
UNIT B
Provider Business Practice Location Address City Name:
BETHEL
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06801-2106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-796-0143
Provider Business Practice Location Address Fax Number:
203-796-0163
Provider Enumeration Date:
09/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FREDHEIM
Authorized Official First Name:
HAROLD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
203-852-0773

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004180593 . This is a "WELLCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: A893738 . This is a "OXFORD HEALTH PLANS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 12DME0964CT02 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004180593 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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