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General NPI Number Information
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NPI Number | 1801054846
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Entity Type | Organization
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Legal Business Name | BEAUTIFUL AGE HOME CARE LLC
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Dates
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Enumeration Date | 05/27/2008
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 30 GROVE ST
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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 | 203-753-3344
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Fax |
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Provider Business Mailing Address
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Address Line | 30 GROVE ST
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City | WATERBURY
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State | CT
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Zip | 06710-2308
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Country | US
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Telephone | 203-753-3344
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Fax | 203-753-3344
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Authorized Official
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Title or Position | MANAGER
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Name | MR. JOEL MARTELL
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Credential | CG
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Telephone | 203-753-3344
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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 | HCA.0000294
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License Number State | CT
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