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General NPI Number Information
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NPI Number | 1346799939
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Entity Type | Organization
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Legal Business Name | ALLY'S EARTH TOUCH
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Dates
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Enumeration Date | 09/24/2016
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Last Update Date | 09/24/2016
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Provider Practice Location Address
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Address Line | 84 BROAD ST
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City | MILFORD
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State | CT
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Zip | 06460-3383
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Country | US
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Telephone | 203-824-8293
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Fax |
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Provider Business Mailing Address
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Address Line | 247 GOVERNORS HILL RD
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City | OXFORD
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State | CT
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Zip | 06478-1334
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Country | US
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Telephone | 203-824-8293
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ALISON FAND
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Credential |
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Telephone | 203-824-8293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 003322
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License Number State | CT
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