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General NPI Number Information
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NPI Number | 1750978185
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Entity Type | Individual
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Provider Name | ANTHONY MACKAY
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Gender | Male
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Dates
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Enumeration Date | 12/31/2020
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Last Update Date | 12/31/2020
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Provider Practice Location Address
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Address Line | 208 WILLOW STREET
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City | WATERBURY
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State | CT
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Zip | 06710
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Country | US
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Telephone | 475-731-3255
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Fax |
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Provider Business Mailing Address
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Address Line | 176 AMITY RD STE 218
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City | WOODBRIDGE
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State | CT
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Zip | 06525-2239
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Country | US
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Telephone | 475-731-3255
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 0001686
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License Number State | CT
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