Provider Demographics
NPI:1407447105
Name:A1 HUSKY MART LLC DBA GOOD FAITH CARE INC.
Entity Type:Organization
Organization Name:A1 HUSKY MART LLC DBA GOOD FAITH CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MALLIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUDHAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-785-8162
Mailing Address - Street 1:786 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-3071
Mailing Address - Country:US
Mailing Address - Phone:860-785-8162
Mailing Address - Fax:
Practice Address - Street 1:786 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-3071
Practice Address - Country:US
Practice Address - Phone:860-785-8162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT019308923OtherHOME CARE