Provider Demographics
NPI:1518733302
Name:MARLY TELFORT
Entity Type:Organization
Organization Name:MARLY TELFORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TELFORT
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:203-768-1509
Mailing Address - Street 1:58 BIRDSEYE RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-2102
Mailing Address - Country:US
Mailing Address - Phone:203-768-1509
Mailing Address - Fax:
Practice Address - Street 1:58 BIRDSEYE RD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-2102
Practice Address - Country:US
Practice Address - Phone:203-768-1509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health