Provider Demographics
NPI:1588995708
Name:DOMUS REALTORS & ASSOCIATES LLC
Entity type:Organization
Organization Name:DOMUS REALTORS & ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:MARION
Authorized Official - Last Name:BATTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR/OWNER
Authorized Official - Phone:203-287-7550
Mailing Address - Street 1:212 BLUE HILLS RD
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-1053
Mailing Address - Country:US
Mailing Address - Phone:203-287-7550
Mailing Address - Fax:203-907-1000
Practice Address - Street 1:212 BLUE HILLS RD
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-1053
Practice Address - Country:US
Practice Address - Phone:203-287-7550
Practice Address - Fax:203-907-1000
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOMUS REALTORS & ASSOCIATES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTHCA0000418302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization