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NPI Code Detail

MEDICARE: PETALS PERSONAL HOMECARE AGENCY LLC

MEDICARE: PETALS PERSONAL HOMECARE AGENCY 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
1372600000XAdult Companion
2374U00000XHome Health Aide
3376K00000XNurse's Aide
4376J00000XHomemaker

General Provider Information

NPI Number : 1699625244
Entity Type Code : Organization
Provider Name (Legal Business Name) : PETALS PERSONAL HOMECARE AGENCY LLC
Provider Business Mailing Address
First Line : 21 WOOD TER
Second Line :
City : BRIDGEPORT
State : CT
Zip : 06604-2432
Country : US
Telephone Number : 929-944-5908
Fax Number :
Provider Business Practice Location Address
First Line : 21 WOOD TER
Second Line :
City : BRIDGEPORT
State : CT
Zip : 06604-2432
Country : US
Telephone Number : 929-944-5908
Fax Number :
Authorized Official
Title or Position : MANAGING MEMBER
Name : PETA-GAY N SIMMONDS-CARROO
Credential : CNA
Telephone Number : 929-944-5908
Provider Enumeration Date : 02/02/2026
Last Update Date : 02/02/2026

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Directions to “PETALS PERSONAL HOMECARE AGENCY LLC ” Practice Location

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