MEDICARE: PERSIS 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	:	1780224998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSIS HOME CARE

Provider Business Mailing Address
First Line	:	115 ARDALE ST
Second Line	:
City	:	WEST HAVEN
State	:	CT
Zip	:	06516-1834
Country	:	US
Telephone Number	:	703-459-0259
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 ARDALE ST
Second Line	:
City	:	WEST HAVEN
State	:	CT
Zip	:	06516-1834
Country	:	US
Telephone Number	:	703-459-0259
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	REUBEN NTREH
Credential	:
Telephone Number	:	703-459-0259

Provider Enumeration Date	:	01/15/2020
Last Update Date	:	01/17/2020

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