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General NPI Number Information
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NPI Number | 1346601986
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Entity Type | Organization
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Legal Business Name | AUTHENTIC HEALTH CARE LLC
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Dates
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Enumeration Date | 03/10/2016
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Last Update Date | 03/10/2016
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Provider Practice Location Address
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Address Line | 335 DEXTER DR
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City | BRIDGEPORT
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State | CT
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Zip | 06606-1305
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Country | US
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Telephone | 203-374-3857
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Fax | 203-540-5569
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Provider Business Mailing Address
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Address Line | 361 WAYNE STREET
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City | BRIDGEPORT
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State | CT
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Zip | 06606
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Country | US
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Telephone | 203-549-8746
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Fax | 203-540-5569
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Authorized Official
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Title or Position | MEMBER
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Name | MRS. CLAUDETTE BLAKE
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Credential |
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Telephone | 203-549-8746
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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 | HHA0000453
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License Number State | CT
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