Healthcare Provider Details

I. General information

NPI: 1437136728
Provider Name (Legal Business Name): MCLEAN AFFILIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 GREAT POND RD
SIMSBURY CT
06070-1980
US

IV. Provider business mailing address

75 GREAT POND RD
SIMSBURY CT
06070-1980
US

V. Phone/Fax

Practice location:
  • Phone: 860-658-3950
  • Fax: 860-408-1319
Mailing address:
  • Phone: 860-658-3950
  • Fax: 860-408-1319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberC8518N
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberC8518N
License Number StateCT

VIII. Authorized Official

Name: MRS. CHERYL KOZIERADZKI
Title or Position: MANAGER
Credential:
Phone: 860-658-3950