=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346628435
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A & C ELDERLY CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2015
-----------------------------------------------------
Last Update Date | 05/11/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 510 BURNSIDE AVENUE
-----------------------------------------------------
City | EAST HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06108-3504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-690-7071
-----------------------------------------------------
Fax | 860-290-1828
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 510 BURNSICE AVE
-----------------------------------------------------
City | EAST HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06108-3504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-830-6070
-----------------------------------------------------
Fax | 860-290-1828
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | CHANEL VERASTEGUI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 860-690-7071
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 0000798
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------