Provider Demographics
NPI:1881814960
Name:LAD FAMILY FIRST
Entity Type:Organization
Organization Name:LAD FAMILY FIRST
Other - Org Name:HOME HELPERS & DIRECT LINK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-269-5552
Mailing Address - Street 1:994 NORTH COLONY RD
Mailing Address - Street 2:SUITE #343
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-5902
Mailing Address - Country:US
Mailing Address - Phone:203-269-5552
Mailing Address - Fax:203-265-3512
Practice Address - Street 1:999 NORTH COLONY RD
Practice Address - Street 2:SUITE 343
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-5902
Practice Address - Country:US
Practice Address - Phone:203-269-5552
Practice Address - Fax:203-265-3512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1806090000171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004LADF492Medicaid