Healthcare Provider Details

I. General information

NPI: 1336178474
Provider Name (Legal Business Name): PATIENT'S CHOICE HOMECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 SILAS DEANE HIGHWAY
WETHERSFIELD CT
06109-2104
US

IV. Provider business mailing address

346 DELAWARE AVE
BUFFALO NY
14202-1804
US

V. Phone/Fax

Practice location:
  • Phone: 860-561-0599
  • Fax: 860-561-0394
Mailing address:
  • Phone: 716-856-7500
  • Fax: 716-856-7506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0012
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier004238962
Identifier TypeMEDICAID
Identifier StateCT
Identifier Issuer

VIII. Authorized Official

Name: MR. PATRICK TODD LYLES
Title or Position: SR. VP OF ADMINISTRATION
Credential:
Phone: 502-891-1000