Provider Demographics
NPI:1043476005
Name:CONNECTICUT SUPPORT SERVICES HOLDINGS, LLC
Entity Type:Organization
Organization Name:CONNECTICUT SUPPORT SERVICES HOLDINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAIFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-426-9868
Mailing Address - Street 1:786 W QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-1060
Mailing Address - Country:US
Mailing Address - Phone:860-426-9868
Mailing Address - Fax:860-426-9869
Practice Address - Street 1:786 W QUEEN ST
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-1060
Practice Address - Country:US
Practice Address - Phone:860-426-9868
Practice Address - Fax:860-426-9869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT6148260001Medicare NSC