Provider Demographics
NPI:1467509604
Name:AMERICARE MEDICAL SUPPLY L.L.C.
Entity Type:Organization
Organization Name:AMERICARE MEDICAL SUPPLY L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER OF LLC
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-228-0606
Mailing Address - Street 1:PO BOX 342
Mailing Address - Street 2:7 LIBERTY DRIVE
Mailing Address - City:HEBRON
Mailing Address - State:CT
Mailing Address - Zip Code:06248-0342
Mailing Address - Country:US
Mailing Address - Phone:860-228-0606
Mailing Address - Fax:860-228-6903
Practice Address - Street 1:7 LIBERTY DR
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:CT
Practice Address - Zip Code:06248-0342
Practice Address - Country:US
Practice Address - Phone:860-228-0606
Practice Address - Fax:860-228-6903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004190261Medicaid
CT12DME0667CT01OtherANTHEM OF CT-DME
CT1230900001Medicare NSC