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General NPI Number Information
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NPI Number | 1174201248
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Entity Type | Organization
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Legal Business Name | PETALS HOME SERVICES
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Dates
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Enumeration Date | 07/10/2023
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 157 CHURCH ST FL 19
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City | NEW HAVEN
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State | CT
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Zip | 06510-2100
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Country | US
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Telephone | 203-507-4236
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Fax |
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Provider Business Mailing Address
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Address Line | 157 CHURCH ST FL 19
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City | NEW HAVEN
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State | CT
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Zip | 06510-2100
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Country | US
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Telephone | 203-507-4236
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRYA SNOW WHITE
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Credential |
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Telephone | 475-204-4236
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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 |
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License Number State |
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