Provider Demographics
NPI:1992709307
Name:CONNECTICUT SUPPORT SERVICES, LLC
Entity type:Organization
Organization Name:CONNECTICUT SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:DUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-793-6843
Mailing Address - Street 1:444 EAST STREET
Mailing Address - Street 2:PO BOX 486
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-0486
Mailing Address - Country:US
Mailing Address - Phone:860-793-6843
Mailing Address - Fax:860-747-1266
Practice Address - Street 1:444 EAST ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-3261
Practice Address - Country:US
Practice Address - Phone:860-793-6843
Practice Address - Fax:860-747-1266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Not Answered332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT12DME0553CT01OtherBLUE CROSS BLUE SHIELD
CT1089080001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER