Provider Demographics
NPI:1366889842
Name:MAYFLOWER QUALITY CARE LLC.
Entity type:Organization
Organization Name:MAYFLOWER QUALITY CARE LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-817-7589
Mailing Address - Street 1:210 PLAINFIELD ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06112-1364
Mailing Address - Country:US
Mailing Address - Phone:869-817-7589
Mailing Address - Fax:860-219-9465
Practice Address - Street 1:210 PLAINFIELD ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112-1364
Practice Address - Country:US
Practice Address - Phone:869-817-7589
Practice Address - Fax:860-219-9465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
CTHCA.0000752251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management