Provider Demographics
NPI:1336800333
Name:PALISADES HOME CARE
Entity Type:Organization
Organization Name:PALISADES HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARYN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-678-3005
Mailing Address - Street 1:1 PADANARAM RD
Mailing Address - Street 2:STE 148
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811
Mailing Address - Country:US
Mailing Address - Phone:203-678-3005
Mailing Address - Fax:203-300-5076
Practice Address - Street 1:1 PADANARAM RD
Practice Address - Street 2:STE 148
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811
Practice Address - Country:US
Practice Address - Phone:203-678-3005
Practice Address - Fax:203-300-5076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care