1558655175 NPI number — DEPENDABLE HOME CARE SERVICE LLC

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 1558655175 NPI number — DEPENDABLE HOME CARE SERVICE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEPENDABLE HOME CARE SERVICE 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:
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:
1558655175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 SHELTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-654-5187
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
472 WINTERGREEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMDEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06514-3240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-654-5187
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KEITAZULU
Authorized Official First Name:
SUNDIATA
Authorized Official Middle Name:
CHAKA
Authorized Official Title or Position:
SALES MANAGER
Authorized Official Telephone Number:
203-654-5187

Provider Taxonomy Codes

  • Taxonomy code: 302F00000X , with the licence number:  HCA0000492 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 302R00000X , with the licence number: HCAOOOO492 , 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)





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