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General NPI Number Information
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NPI Number | 1154685063
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Entity Type | Organization
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Legal Business Name | CARE OF FAIRFIELD LLC
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Dates
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Enumeration Date | 06/26/2012
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Last Update Date | 06/26/2012
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Provider Practice Location Address
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Address Line | 2228 BLACK ROCK TPKE STILLSON PLAZA, SUITE 310
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City | FAIRFIELD
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State | CT
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Zip | 06825-3237
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Country | US
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Telephone | 203-923-8866
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Fax | 203-726-7266
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Provider Business Mailing Address
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Address Line | 2228 BLACK ROCK TPKE STILLSON PLAZA, SUITE 310
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City | FAIRFIELD
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State | CT
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Zip | 06825-3237
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Country | US
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Telephone | 203-923-8866
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Fax | 203-726-7266
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. BERNARD JOHN KILEY JR.
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Credential |
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Telephone | 203-923-8866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | HCA.0000644
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License Number State | CT
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