Provider Demographics
NPI:1922470772
Name:PURPLE HEARTS HOME CARE LLC
Entity Type:Organization
Organization Name:PURPLE HEARTS HOME CARE LLC
Other - Org Name:PURPLE HEARTS HOME CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TWUMASI
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:860-310-5553
Mailing Address - Street 1:360 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-2700
Mailing Address - Country:US
Mailing Address - Phone:860-819-8954
Mailing Address - Fax:
Practice Address - Street 1:360 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2700
Practice Address - Country:US
Practice Address - Phone:860-819-8954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PURPLE HEARTS HOMECARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1180737302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization