=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386523306
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ECS-01 LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2025
-----------------------------------------------------
Last Update Date | 09/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31 KINGSBURY AVE
-----------------------------------------------------
City | TOLLAND
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-645-9500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 750 MAIN ST
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06040-5101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-645-9500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. SAMUEL TAGGARD
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 866-645-9500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------