=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447554068
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELIZABETH'S HOME HEALTH CARE AGENCY L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2010
-----------------------------------------------------
Last Update Date | 04/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 127 CEDAR STREET
-----------------------------------------------------
City | BRONFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-488-8889
-----------------------------------------------------
Fax | 203-315-9200
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 937 127 CEDAR STREET
-----------------------------------------------------
City | BRONFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-488-8889
-----------------------------------------------------
Fax | 203-315-9200
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. HEATHER L SUPPA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 203-488-8889
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HCA0000405
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------