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General NPI Number Information
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NPI Number | 1396454351
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Entity Type | Organization
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Legal Business Name | HEARTS AT HOME L.L.C.
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Dates
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Enumeration Date | 11/18/2022
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Last Update Date | 11/18/2022
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Provider Practice Location Address
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Address Line | 499 AMITY RD
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City | WOODBRIDGE
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State | CT
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Zip | 06525-1603
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Country | US
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Telephone | 203-886-9307
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Fax |
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Provider Business Mailing Address
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Address Line | 499 AMITY RD
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City | WOODBRIDGE
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State | CT
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Zip | 06525-1603
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BECKET GRETEN-HARRISON
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Credential |
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Telephone | 203-886-9307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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