Active NPI
Mercy Home Care of Connecticut LLC
- Durable Medical Equipment & Medical Supplies
- Bethel, CT
National Provider Identifier
1154481562
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- License
- CSW.000.3005
- Legal business name
- MERCY HOME CARE OF CONNECTICUT LLC
- Practice address
- 230 Greenwood Ave
Bethel, CT 06801-2117 - Phone
- (203) 617-0606
- Fax
- (203) 617-0609
- NPI assigned
- Dec 8, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Harold J Fredheim
- Title
- Ceo
- Phone
- (203) 617-0606
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | CSW.000.3005 | CT | Primary |
Addresses
Primary practice location
230 Greenwood Ave
Bethel, CT 06801-2117
Mailing address
230 Greenwood Ave
Bethel, CT 06801-2117
Phone (203) 617-0606
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004180593 | Medicaid | CT | |
| 004180593 | Other | CT | WELLCARE MANAGED MEDICAID |
| 12DME0964CT01 | Other | CT | ANTHEM BC/BS |
Other names 1
- Mercy Home Care/Mercy Cares Boutique
National Provider Directory
National Provider DirectoryLocations
230 Greenwood Ave
Bethel, CT 06801
Phone (203) 617-0606
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165536000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1424908800000",
"number": "1154481562",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "230 GREENWOOD AVE",
"city": "BETHEL",
"state": "CT",
"postal_code": "068012117",
"telephone_number": "203-617-0606",
"fax_number": "203-617-0609"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "230 GREENWOOD AVE",
"city": "BETHEL",
"state": "CT",
"postal_code": "068012117",
"telephone_number": "203-617-0606",
"fax_number": "203-617-0609"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MERCY HOME CARE OF CONNECTICUT LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-12-08",
"last_updated": "2015-02-26",
"status": "A",
"authorized_official_last_name": "FREDHEIM",
"authorized_official_first_name": "HAROLD",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "203-617-0606"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "CT",
"license": "CSW.000.3005",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004180593",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE MANAGED MEDICAID",
"identifier": "004180593",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BC/BS",
"identifier": "12DME0964CT01",
"state": "CT"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Mercy Home Care/Mercy Cares Boutique",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Bethel, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.