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General NPI Number Information
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NPI Number | 1922981729
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Entity Type | Individual
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Provider Name | GERALD MACKINNON
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Gender | Male
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Dates
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Enumeration Date | 07/29/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 3 WOODCHUCK HILL RD
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City | WEST SIMSBURY
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State | CT
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Zip | 06092-2322
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Country | US
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Telephone | 860-268-3385
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Fax | 860-268-3385
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Provider Business Mailing Address
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Address Line | 3 WOODCHUCK HILL RD
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City | WEST SIMSBURY
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State | CT
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Zip | 06092-2322
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Country | US
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Telephone | 860-392-9651
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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 | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 861298601
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License Number State | CT
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