=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538939400
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OUR CARE IN HOME SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2024
-----------------------------------------------------
Last Update Date | 01/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 58 MANSFIELD ST
-----------------------------------------------------
City | HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06112-1938
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-602-5347
-----------------------------------------------------
Fax | 774-521-3746
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 141 ROUTE 6A STE 3
-----------------------------------------------------
City | SANDWICH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02563-2077
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-368-4797
-----------------------------------------------------
Fax | 774-521-3746
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LOVINE KERRON REID
-----------------------------------------------------
Credential | CNA
-----------------------------------------------------
Telephone | 774-368-4797
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------