Healthcare Provider Details

I. General information

NPI: 1861169930
Provider Name (Legal Business Name): CLASSIC HOMEMAKERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BROAD ST APT A
DANIELSON CT
06239-3603
US

IV. Provider business mailing address

100 BROAD ST APT A
DANIELSON CT
06239-3603
US

V. Phone/Fax

Practice location:
  • Phone: 860-576-4995
  • Fax: 860-779-1770
Mailing address:
  • Phone: 860-576-4995
  • Fax: 860-779-1770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: GINA A PEREZ
Title or Position: 0WNER
Credential:
Phone: 860-576-4995