Provider Demographics
NPI:1588902563
Name:CT HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:CT HEALTHCARE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:BABU
Authorized Official - Last Name:KURRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-223-0522
Mailing Address - Street 1:46 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-4305
Mailing Address - Country:US
Mailing Address - Phone:860-223-0522
Mailing Address - Fax:860-223-0822
Practice Address - Street 1:46 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-4305
Practice Address - Country:US
Practice Address - Phone:860-223-0522
Practice Address - Fax:860-223-0822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-24
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 3336L0003X
CTPCY00022603336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2138939OtherPK
CT7064150001Medicare NSC