Organization
MERCY HOME CARE OF CONNECTICUT LLC
Active
Other names
Mercy Home Care/Mercy Cares Boutique
Organization subpart
No
Provider details
NPI number
Authorized official
HAROLD J FREDHEIM (CEO)
(203) 617-0606
Entity
Organization
Contact information
Practice address
230 GREENWOOD AVE, BETHEL, CT 06801-2117
(203) 617-0606
(203) 617-0609
Mailing address
230 GREENWOOD AVE, BETHEL, CT 06801-2117
(203) 617-0606
(203) 617-0609
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
CSW.000.3005
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004180593
WELLCARE MANAGED MEDICAID
CT
05
—
004180593
—
CT
01
—
12DME0964CT01
ANTHEM BC/BS
CT
Enumeration date
12/08/2006
Last updated
02/26/2015
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