Healthcare Provider Details

I. General information

NPI: 1255837621
Provider Name (Legal Business Name): OUR FAMILY HOME HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 GRANFIELD AVE
BRIDGEPORT CT
06610-2305
US

IV. Provider business mailing address

435 S 5TH AVE
MOUNT VERNON NY
10550-4417
US

V. Phone/Fax

Practice location:
  • Phone: 203-916-9020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: SHAQUILLE HENRY
Title or Position: OWNER
Credential:
Phone: 203-908-5641