Healthcare Provider Details

I. General information

NPI: 1689055246
Provider Name (Legal Business Name): GORDONS PROFESSIONAL CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 MILL POND RD # T33
BROAD BROOK CT
06016-9600
US

IV. Provider business mailing address

59 MILL POND RD # T33
BROAD BROOK CT
06016-9600
US

V. Phone/Fax

Practice location:
  • Phone: 860-335-8697
  • Fax:
Mailing address:
  • Phone: 860-335-8697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: ASHANTIA HOLIZA GORDON
Title or Position: OWNER
Credential:
Phone: 860-335-8697