Provider Demographics
NPI:1346799939
Name:ALLY'S EARTH TOUCH
Entity Type:Organization
Organization Name:ALLY'S EARTH TOUCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:FAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-824-8293
Mailing Address - Street 1:247 GOVERNORS HILL RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-1334
Mailing Address - Country:US
Mailing Address - Phone:203-824-8293
Mailing Address - Fax:
Practice Address - Street 1:84 BROAD ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3383
Practice Address - Country:US
Practice Address - Phone:203-824-8293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-24
Last Update Date:2016-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003322302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization