=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023489424
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HERCULES HELPING HANDS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2015
-----------------------------------------------------
Last Update Date | 10/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 750 MAIN ST SUITE 305
-----------------------------------------------------
City | HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06103-2703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-751-9101
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 750 MAIN ST SUITE 305
-----------------------------------------------------
City | HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06103-2703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-751-9101
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COUNSEL & VICE PRESIDENT
-----------------------------------------------------
Name | MRS. TIANA VICTORIA HERCULES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 860-751-9101
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 0000815
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------