MEDICARE: LIFE CHOICE HOSPICE OF CONNECTICUT LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician
2	363LF0000X	Family Nurse Practitioner
3	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1457949208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE CHOICE HOSPICE OF CONNECTICUT LLC

Provider Business Mailing Address
First Line	:	10 CADILLAC DR STE 400
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-1001
Country	:	US
Telephone Number	:	615-377-7022
Fax Number	:	615-373-4457

Provider Business Practice Location Address
First Line	:	612 WHEELERS FARMS RD STE 103
Second Line	:
City	:	MILFORD
State	:	CT
Zip	:	06461-1673
Country	:	US
Telephone Number	:	203-301-0489
Fax Number	:	203-301-0632

Authorized Official
Title or Position	:	SVP CHIEF LEGAL OFFICER
Name	:	RUSSELL ADKINS
Credential	:
Telephone Number	:	615-309-5668

Provider Enumeration Date	:	01/07/2021
Last Update Date	:	01/07/2021

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