MEDICARE: ORANGE WHIP, INC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1215558101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORANGE WHIP, INC

Provider Business Mailing Address
First Line	:	151 EAST ST STE 101
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-5916
Country	:	US
Telephone Number	:	203-646-8855
Fax Number	:

Provider Business Practice Location Address
First Line	:	151 EAST ST STE 101
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-5916
Country	:	US
Telephone Number	:	203-646-8855
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MATTHEW ERIC PETERSON
Credential	:
Telephone Number	:	203-646-8855

Provider Enumeration Date	:	05/01/2020
Last Update Date	:	05/01/2020

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