Provider Demographics
NPI:1003119140
Name:MEHDI LLC
Entity Type:Organization
Organization Name:MEHDI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNA,PCT, MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AJMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHDI
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:860-583-3338
Mailing Address - Street 1:210 MAIN ST # 1423
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-9992
Mailing Address - Country:US
Mailing Address - Phone:860-583-3338
Mailing Address - Fax:860-582-2226
Practice Address - Street 1:37 CENTER ST
Practice Address - Street 2:511 PINE STREET
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4917
Practice Address - Country:US
Practice Address - Phone:860-583-3338
Practice Address - Fax:860-582-2226
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICS HOME HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTNA9992331251E00000X
CTHCA.0000440320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No251E00000XAgenciesHome Health