Healthcare Provider Details

I. General information

NPI: 1932012267
Provider Name (Legal Business Name): PERSONALIZED HOMECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 TRUMBULL LN
SOUTH WINDSOR CT
06074-2370
US

IV. Provider business mailing address

35 TALCOTTVILLE RD STE 10
VERNON ROCKVILLE CT
06066-5261
US

V. Phone/Fax

Practice location:
  • Phone: 959-250-8611
  • Fax: 860-926-2911
Mailing address:
  • Phone: 959-250-8611
  • Fax: 860-926-2911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS STEFANIE COUGHLIN
Title or Position: OWNER
Credential: RN
Phone: 959-250-8611