=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205682028
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHOSEN HOME CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2024
-----------------------------------------------------
Last Update Date | 04/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 486 PALMETTO RD
-----------------------------------------------------
City | BRIDGEPORT
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06606-1217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-032-5271
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 486 PALMETTO RD
-----------------------------------------------------
City | BRIDGEPORT
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06606-1217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-032-5271
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | FELISA FANTASIA EDNEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 475-319-0427
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------