Healthcare Provider Details

I. General information

NPI: 1083063481
Provider Name (Legal Business Name): FMCH DBA GRISWOLD HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 BROADBRIDGE AVE
STRATFORD CT
06615-5888
US

IV. Provider business mailing address

1122 BROADBRIDGE AVE
STRATFORD CT
06615-5888
US

V. Phone/Fax

Practice location:
  • Phone: 203-380-2700
  • Fax: 203-380-1140
Mailing address:
  • Phone: 203-380-2700
  • Fax: 203-380-1140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHCA 0000169
License Number StateCT

VIII. Authorized Official

Name: MRS. CATHY HOWARD
Title or Position: OWNER, PRESIDENT
Credential:
Phone: 203-380-2700