Healthcare Provider Details

I. General information

NPI: 1285072090
Provider Name (Legal Business Name): DEPENDABLE HOME CARE OF CT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 FORT HILL RD
GROTON CT
06340-4335
US

IV. Provider business mailing address

124 FORT HILL RD
GROTON CT
06340-4335
US

V. Phone/Fax

Practice location:
  • Phone: 401-491-9003
  • Fax: 401-491-9054
Mailing address:
  • Phone: 401-491-9003
  • Fax: 401-491-9054

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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. EPHRAIM U JACOB
Title or Position: PRESIDENT/CEO
Credential:
Phone: 401-491-9003