Provider Demographics
NPI:1598102287
Name:JOSIAH SERVICES UNLIMITED LLC
Entity Type:Organization
Organization Name:JOSIAH SERVICES UNLIMITED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:NICHOLA
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-578-9179
Mailing Address - Street 1:880 ASYLUM AVE STE 3
Mailing Address - Street 2:PO BOX 330452
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1973
Mailing Address - Country:US
Mailing Address - Phone:860-578-9179
Mailing Address - Fax:860-578-9179
Practice Address - Street 1:880 ASYLUM AVE STE 3
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1973
Practice Address - Country:US
Practice Address - Phone:860-578-9179
Practice Address - Fax:860-578-9179
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSIAH SERVICES UNLIMITED LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008043251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT747488OtherVALUE OPTIONS