1558360529 NPI number — HOMECARE PROFESSIONALS

Table of content: (NPI 1558360529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558360529 NPI number — HOMECARE PROFESSIONALS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOMECARE PROFESSIONALS
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:
1558360529
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1587 HAMILTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06706-2403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-754-1850
Provider Business Mailing Address Fax Number:
203-573-1308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1587 HAMILTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06706-2403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-754-1850
Provider Business Practice Location Address Fax Number:
203-573-1308
Provider Enumeration Date:
07/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
AWWAD
Authorized Official First Name:
F
Authorized Official Middle Name:
GEORGE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
203-754-1850

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 12DME0605CT . This is a "BLUE CROSS DME" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 713285 . This is a "CTCARE PROVIDER NUMBER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 898883 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 150 . This is a "BLUE CROSS INFUSION PROVI" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: A782569 . This is a "OXFORD PROVIDER NUMBER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1019608 . This is a "ACM PROVIDER NUMBER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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