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General NPI Number Information
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NPI Number | 1588946917
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Entity Type | Organization
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Legal Business Name | MAYFLOWER QUALITY CARE
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Dates
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Enumeration Date | 09/12/2011
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Last Update Date | 09/12/2011
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Provider Practice Location Address
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Address Line | 210 PLAINFIELD ST
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City | HARTFORD
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State | CT
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Zip | 06112-1364
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Country | US
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Telephone | 860-817-7589
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 380587
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City | EAST HARTFORD
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State | CT
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Zip | 06138-0587
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Country | US
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Telephone | 860-269-3058
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DUANE EDWARD MACK
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Credential |
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Telephone | 860-269-3058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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