=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275402323
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LONG LIFE RIDES HOME CARE AND RESIDENTIAL SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2025
-----------------------------------------------------
Last Update Date | 11/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 290 PRATT ST STE 2303-05
-----------------------------------------------------
City | MERIDEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06450-8600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-379-8044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45 FAIRFIELD ST
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06040-5755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MESSANVI PATRICK BARTHELEMY AMENOUNVE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 203-379-8044
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------