Provider Demographics
NPI:1750635967
Name:COMPLETE IN-HOME THERAPY LLC
Entity Type:Organization
Organization Name:COMPLETE IN-HOME THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RPT
Authorized Official - Phone:860-573-4923
Mailing Address - Street 1:430 MANSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ASHFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06278-1416
Mailing Address - Country:US
Mailing Address - Phone:860-573-4923
Mailing Address - Fax:
Practice Address - Street 1:430 MANSFIELD RD
Practice Address - Street 2:
Practice Address - City:ASHFORD
Practice Address - State:CT
Practice Address - Zip Code:06278-1416
Practice Address - Country:US
Practice Address - Phone:860-573-4923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-09
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTLLC 1084683261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty