MEDICARE: DEPENDABLE HOME CARE SERVICE LLC

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	302F00000X	Exclusive Provider Organization	HCA0000492	CT
2	302R00000X	Health Maintenance Organization	HCAOOOO492	CT

General Provider Information

NPI Number	:	1558655175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEPENDABLE HOME CARE SERVICE LLC

Provider Business Mailing Address
First Line	:	209 SHELTON AVE
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06511
Country	:	US
Telephone Number	:	203-654-5187
Fax Number	:

Provider Business Practice Location Address
First Line	:	472 WINTERGREEN AVE
Second Line	:
City	:	HAMDEN
State	:	CT
Zip	:	06514-3240
Country	:	US
Telephone Number	:	203-654-5187
Fax Number	:

Authorized Official
Title or Position	:	SALES MANAGER
Name	:	MR. SUNDIATA CHAKA KEITAZULU
Credential	:	ETC
Telephone Number	:	203-654-5187

Provider Enumeration Date	:	05/31/2011
Last Update Date	:	05/31/2011

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Directions to “DEPENDABLE HOME CARE SERVICE LLC ” Practice Location

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