Healthcare Provider Details

I. General information

NPI: 1639330434
Provider Name (Legal Business Name): PRIORITY HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 MIX AVE # C
HAMDEN CT
06514-2354
US

IV. Provider business mailing address

609 MIX AVE # C
HAMDEN CT
06514-2354
US

V. Phone/Fax

Practice location:
  • Phone: 203-506-0754
  • Fax:
Mailing address:
  • Phone: 203-506-0754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: FAITH KASOR GBATU
Title or Position: OWNER
Credential:
Phone: 203-506-0754