Provider Demographics
NPI:1568807519
Name:LIFETIME AUTISTIC HOMECARE, LLC
Entity Type:Organization
Organization Name:LIFETIME AUTISTIC HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-794-9731
Mailing Address - Street 1:54 WELLS AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-2269
Mailing Address - Country:US
Mailing Address - Phone:860-794-9731
Mailing Address - Fax:
Practice Address - Street 1:54 WELLS AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-2269
Practice Address - Country:US
Practice Address - Phone:860-794-9731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTHCA.0000759251B00000X, 251C00000X, 251S00000X, 253Z00000X, 347C00000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No347C00000XTransportation ServicesPrivate Vehicle
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child