1235475336 NPI number — HESTIA CARE SERVICES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235475336 NPI number — HESTIA CARE SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HESTIA CARE SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235475336
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26 SAINT PAUL ST
Provider Second Line Business Mailing Address:
#8
Provider Business Mailing Address City Name:
BROOKLINE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02446-6573
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-910-2205
Provider Business Mailing Address Fax Number:
800-650-9383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
275 GROVE ST
Provider Second Line Business Practice Location Address:
SUITE 2-400
Provider Business Practice Location Address City Name:
AUBURNDALE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02466-2272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-910-2200
Provider Business Practice Location Address Fax Number:
800-650-9383
Provider Enumeration Date:
12/17/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RUDRA
Authorized Official First Name:
BALU
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
617-910-2205

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  8282 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)