Provider Demographics
NPI:1851969489
Name:SUPPORTIVE THREADS LLC
Entity Type:Organization
Organization Name:SUPPORTIVE THREADS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ELDERKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-605-8963
Mailing Address - Street 1:300 WINDING BROOK DRIVE
Mailing Address - Street 2:LEVEL 2 STE 4
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033
Mailing Address - Country:US
Mailing Address - Phone:203-605-8963
Mailing Address - Fax:
Practice Address - Street 1:300 WINDING BROOK DRIVE
Practice Address - Street 2:LEVEL 2 STE 4
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033
Practice Address - Country:US
Practice Address - Phone:203-605-8963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-10
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies