Provider Demographics
NPI:1558655175
Name:DEPENDABLE HOME CARE SERVICE LLC
Entity Type:Organization
Organization Name:DEPENDABLE HOME CARE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SALES MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNDIATA
Authorized Official - Middle Name:CHAKA
Authorized Official - Last Name:KEITAZULU
Authorized Official - Suffix:
Authorized Official - Credentials:ETC
Authorized Official - Phone:203-654-5187
Mailing Address - Street 1:209 SHELTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511
Mailing Address - Country:US
Mailing Address - Phone:203-654-5187
Mailing Address - Fax:
Practice Address - Street 1:472 WINTERGREEN AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-3240
Practice Address - Country:US
Practice Address - Phone:203-654-5187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTHCA0000492302F00000X
CTHCAOOOO492302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No302F00000XManaged Care OrganizationsExclusive Provider Organization