1871569707 NPI number — PATHWELL CT, INC.

Table of content: (NPI 1871569707)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871569707 NPI number — PATHWELL CT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATHWELL CT, 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:
SHAMROCK HOME CARE
Provider Other Organization Name Type Code:
3
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:
1871569707
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
99 HAWLEY LN STE 1001
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STRATFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06614-1204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-256-1804
Provider Business Mailing Address Fax Number:
203-259-8523

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99 HAWLEY LN STE 1001
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STRATFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06614-1204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-256-1804
Provider Business Practice Location Address Fax Number:
203-259-8523
Provider Enumeration Date:
02/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
QUINN
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
475-256-0871

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  C9206505 , 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: 1871569707 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 298 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: CU3190 . This is a "CCS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0V9964 . This is a "HEALTH NET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004114104 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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