MEDICARE: PARK CITY HOME CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1033988316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK CITY HOME CARE

Provider Business Mailing Address
First Line	:	80 ELM ST
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06604-4115
Country	:	US
Telephone Number	:	203-870-8008
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 ELM ST
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06604-4115
Country	:	US
Telephone Number	:	203-870-8008
Fax Number	:	203-330-8007

Authorized Official
Title or Position	:	CEO
Name	:	LUIS VILLEGAS
Credential	:
Telephone Number	:	203-870-8008

Provider Enumeration Date	:	12/27/2023
Last Update Date	:	01/01/2024

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Directions to “PARK CITY HOME CARE ” Practice Location

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