Healthcare Provider Details

I. General information

NPI: 1215398920
Provider Name (Legal Business Name): VCARE FAMILY PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2016
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 UNION STREET
VERNON CT
06066-3025
US

IV. Provider business mailing address

145 UNION STREET
VERNON CT
06066-3025
US

V. Phone/Fax

Practice location:
  • Phone: 860-375-8440
  • Fax: 860-858-4091
Mailing address:
  • Phone: 860-375-8440
  • Fax: 860-858-4091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number005393
License Number StateCT

VIII. Authorized Official

Name: MR. MOHAMED ALTAF HUSSAIN
Title or Position: CEO/ADVANCE PRACTICE REGISTERED NUR
Credential: APRN, MBBS
Phone: 860-324-7988