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General NPI Number Information
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NPI Number | 1699625244
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Entity Type | Organization
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Legal Business Name | PETALS PERSONAL HOMECARE AGENCY LLC
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Dates
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Enumeration Date | 02/02/2026
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 21 WOOD TER
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City | BRIDGEPORT
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State | CT
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Zip | 06604-2432
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Country | US
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Telephone | 929-944-5908
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Fax |
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Provider Business Mailing Address
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Address Line | 21 WOOD TER
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City | BRIDGEPORT
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State | CT
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Zip | 06604-2432
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Country | US
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Telephone | 929-944-5908
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | PETA-GAY N SIMMONDS-CARROO
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Credential | CNA
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Telephone | 929-944-5908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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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 | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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