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General NPI Number Information
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NPI Number | 1225518178
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Entity Type | Organization
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Legal Business Name | GEORGINA HOME CARE LLC
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Dates
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Enumeration Date | 08/20/2018
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Last Update Date | 08/20/2018
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Provider Practice Location Address
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Address Line | 40 RICHARDS AVE STE 3
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City | NORWALK
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State | CT
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Zip | 06854-2320
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Country | US
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Telephone | 203-997-5337
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Fax |
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Provider Business Mailing Address
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Address Line | 40 RICHARDS AVE STE 3
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City | NORWALK
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State | CT
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Zip | 06854-2320
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Country | US
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Telephone | 203-997-5337
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ROXANE GALLAHAR
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Credential |
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Telephone | 203-997-5337
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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.0001455
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License Number State | CT
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