Healthcare Provider Details

I. General information

NPI: 1144094392
Provider Name (Legal Business Name): EMINENCE CT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/08/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1838 SILAS DEANE HIGHWAY
ROCKY HILL CT
06067
US

IV. Provider business mailing address

1838 SILAS DEANE HIGHWAY
ROCKY HILL CT
06067
US

V. Phone/Fax

Practice location:
  • Phone: 860-436-9260
  • Fax: 860-436-9302
Mailing address:
  • Phone: 860-436-9260
  • Fax: 860-436-9302

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CHESKEL SPITZER
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 347-232-4641