Provider Demographics
NPI:1184873424
Name:MERCY HOME CARE OF CONNECTICUT, INC.
Entity type:Organization
Organization Name:MERCY HOME CARE OF CONNECTICUT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:J
Authorized Official - Last Name:FREDHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-852-0773
Mailing Address - Street 1:28 KNIGHT ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-4719
Mailing Address - Country:US
Mailing Address - Phone:203-852-0773
Mailing Address - Fax:203-299-0415
Practice Address - Street 1:2 LIBRARY PL
Practice Address - Street 2:UNIT B
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-2106
Practice Address - Country:US
Practice Address - Phone:203-796-0143
Practice Address - Fax:203-796-0163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004180593OtherWELLCARE
CTA893738OtherOXFORD HEALTH PLANS
CT12DME0964CT02OtherANTHEM BC/BS
CT004180593Medicaid
CT004180593OtherWELLCARE
CT1201930001Medicare NSC