=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730672270
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARMEN M JULIEN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2018
-----------------------------------------------------
Last Update Date | 06/10/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 435 BUCKLAND RD
-----------------------------------------------------
City | SOUTH WINDSOR
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06074-3720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-820-5232
-----------------------------------------------------
Fax | 860-783-8055
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 435 BUCKLAND RD
-----------------------------------------------------
City | SOUTH WINDSOR
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06074-3720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-820-5232
-----------------------------------------------------
Fax | 860-879-4699
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 82-4421015
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------