Healthcare Provider Details

I. General information

NPI: 1790064178
Provider Name (Legal Business Name): HUMANA AT HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 POST RD STE 304
FAIRFIELD CT
06824-5669
US

IV. Provider business mailing address

845 3RD AVE 7TH FLOOR
NEW YORK NY
10022-6601
US

V. Phone/Fax

Practice location:
  • Phone: 203-318-8445
  • Fax:
Mailing address:
  • Phone: 212-994-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHHC9915705
License Number StateCT

VIII. Authorized Official

Name: DOROTHY BURNS
Title or Position: DIRECTOR, CLINICAL QUALITY
Credential:
Phone: 321-258-7709