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General NPI Number Information
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NPI Number | 1003119140
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Entity Type | Organization
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Legal Business Name | MEHDI LLC
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Dates
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Enumeration Date | 12/13/2010
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Last Update Date | 12/13/2010
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Provider Practice Location Address
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Address Line | 37 CENTER ST 511 PINE STREET
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City | BRISTOL
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State | CT
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Zip | 06010-4917
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Country | US
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Telephone | 860-583-3338
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Fax | 860-582-2226
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Provider Business Mailing Address
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Address Line | 210 MAIN ST # 1423
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City | FARMINGTON
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State | CT
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Zip | 06032-9992
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Country | US
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Telephone | 860-583-3338
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Fax | 860-582-2226
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Authorized Official
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Title or Position | CNA,PCT, MANAGER
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Name | MR. AJMAL MEHDI
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Credential | CNA
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Telephone | 860-583-3338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | NA9992331
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | HCA.0000440
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License Number State | CT
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