=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841445087
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GJ'S HOME CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2008
-----------------------------------------------------
Last Update Date | 12/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 70 PLATT ST
-----------------------------------------------------
City | ANSONIA
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-735-2244
-----------------------------------------------------
Fax | 203-735-2273
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 70 PLATT ST
-----------------------------------------------------
City | ANSONIA
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-735-2244
-----------------------------------------------------
Fax | 203-735-2273
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | MR. LUCIEN LAMARRE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 203-735-2244
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HCA.0000322
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 347C00000X
-----------------------------------------------------
Taxonomy Name | Private Vehicle
-----------------------------------------------------
License Number | 028257364
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number | HCA.0000322
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------