Provider Demographics
NPI:1336178474
Name:PATIENT'S CHOICE HOMECARE, LLC
Entity Type:Organization
Organization Name:PATIENT'S CHOICE HOMECARE, LLC
Other - Org Name:WILLCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VP OF ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:LYLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-891-1000
Mailing Address - Street 1:346 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-1804
Mailing Address - Country:US
Mailing Address - Phone:716-856-7500
Mailing Address - Fax:716-856-7506
Practice Address - Street 1:370 SILAS DEANE HIGHWAY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-2104
Practice Address - Country:US
Practice Address - Phone:860-561-0599
Practice Address - Fax:860-561-0394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0012251E00000X
CT251E00000X, 376J00000X
376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004238962Medicaid
CT077235Medicare PIN
CT07-7235Medicare PIN
CT077235Medicare UPIN
CT004238962Medicaid