Provider Demographics
NPI:1740698869
Name:AVIDCARE THERAPY LLC
Entity type:Organization
Organization Name:AVIDCARE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:P.T./DIRECTOR OF REHAB
Authorized Official - Prefix:
Authorized Official - First Name:ENIOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:UDOYEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT,MPH
Authorized Official - Phone:203-583-1209
Mailing Address - Street 1:58 AUGUSTA DR
Mailing Address - Street 2:58
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-1683
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:58 AUGUSTA DR
Practice Address - Street 2:APT 13C
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06461-1683
Practice Address - Country:US
Practice Address - Phone:203-583-1209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-01
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT010088251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health