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General NPI Number Information
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NPI Number | 1154481562
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Entity Type | Organization
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Legal Business Name | MERCY HOME CARE OF CONNECTICUT LLC
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 02/26/2015
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Provider Practice Location Address
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Address Line | 230 GREENWOOD AVE
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City | BETHEL
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State | CT
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Zip | 06801-2117
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Country | US
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Telephone | 203-617-0606
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Fax | 203-617-0609
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Provider Business Mailing Address
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Address Line | 230 GREENWOOD AVE
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City | BETHEL
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State | CT
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Zip | 06801-2117
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Country | US
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Telephone | 203-617-0606
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Fax | 203-617-0609
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Authorized Official
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Title or Position | CEO
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Name | HAROLD J FREDHEIM
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Credential |
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Telephone | 203-617-0606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | CSW.000.3005
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License Number State | CT
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