Healthcare Provider Details

I. General information

NPI: 1043476005
Provider Name (Legal Business Name): CONNECTICUT SUPPORT SERVICES HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

786 W QUEEN ST
SOUTHINGTON CT
06489-1060
US

IV. Provider business mailing address

786 W QUEEN ST
SOUTHINGTON CT
06489-1060
US

V. Phone/Fax

Practice location:
  • Phone: 860-426-9868
  • Fax: 860-426-9869
Mailing address:
  • Phone: 860-426-9868
  • Fax: 860-426-9869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: DANIEL LAIFER
Title or Position: MEMBER
Credential:
Phone: 860-426-9868