Provider Demographics
NPI:1033988316
Name:PARK CITY HOME CARE
Entity Type:Organization
Organization Name:PARK CITY HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLEGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-870-8008
Mailing Address - Street 1:80 ELM ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-4115
Mailing Address - Country:US
Mailing Address - Phone:203-870-8008
Mailing Address - Fax:
Practice Address - Street 1:80 ELM ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-4115
Practice Address - Country:US
Practice Address - Phone:203-870-8008
Practice Address - Fax:203-330-8007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-27
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health