Provider Demographics
NPI:1316429053
Name:PHASE 2 FACE HOME CARE, LLC
Entity type:Organization
Organization Name:PHASE 2 FACE HOME CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:APPIAH
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:203-604-6939
Mailing Address - Street 1:40 RICHARDS AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-2320
Mailing Address - Country:US
Mailing Address - Phone:203-604-6938
Mailing Address - Fax:203-604-6938
Practice Address - Street 1:40 RICHARDS AVE STE 3
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854-2320
Practice Address - Country:US
Practice Address - Phone:203-604-6938
Practice Address - Fax:203-604-6938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health