Provider Demographics
NPI:1689740961
Name:HOME HEALTH PAVILION INC.
Entity Type:Organization
Organization Name:HOME HEALTH PAVILION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MANSOOR
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:HAIDARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-210-1313
Mailing Address - Street 1:87 DANBURY RD
Mailing Address - Street 2:UNIT #1
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-3413
Mailing Address - Country:US
Mailing Address - Phone:860-210-1313
Mailing Address - Fax:860-354-1123
Practice Address - Street 1:87 DANBURY RD
Practice Address - Street 2:UNIT #1
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-3413
Practice Address - Country:US
Practice Address - Phone:860-210-1313
Practice Address - Fax:860-354-1123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT459952332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT12DME0557CT03OtherBCBS OF CT
CTANC1882OtherOXFORD
CT1135340001Medicare ID - Type Unspecified