Provider Demographics
NPI:1013066760
Name:STAFF MATES INC
Entity Type:Organization
Organization Name:STAFF MATES INC
Other - Org Name:STAFF MATES HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:BESMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-228-4321
Mailing Address - Street 1:5 WEST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:CT
Mailing Address - Zip Code:06248
Mailing Address - Country:US
Mailing Address - Phone:860-228-4321
Mailing Address - Fax:860-228-4491
Practice Address - Street 1:5 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:CT
Practice Address - Zip Code:06248
Practice Address - Country:US
Practice Address - Phone:860-228-4321
Practice Address - Fax:860-228-4491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC9308102251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT671OtherBCBS
CT004118445Medicaid
CT671OtherBCBS