Healthcare Provider Details

I. General information

NPI: 1528047768
Provider Name (Legal Business Name): INTERIM HEALTHCARE OF NORTH HAVEN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 STATE ST
NORTH HAVEN CT
06473-2154
US

IV. Provider business mailing address

278 STATE ST
NORTH HAVEN CT
06473-2154
US

V. Phone/Fax

Practice location:
  • Phone: 203-230-4785
  • Fax: 203-230-4791
Mailing address:
  • Phone: 203-230-4785
  • Fax: 203-230-4791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0006
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number0006
License Number StateCT

VIII. Authorized Official

Name: MR. ERIC ROBERT PETERSEN
Title or Position: PRESIDENT
Credential:
Phone: 203-230-4785