1609053586 NPI number — PRIORITY HOME CARE SERVICES

Table of content: (NPI 1609053586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609053586 NPI number — PRIORITY HOME CARE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIORITY HOME CARE SERVICES
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:
1609053586
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 POPLAR ST
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
ROSLINDALE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02131-2505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-323-2276
Provider Business Mailing Address Fax Number:
617-323-2494

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 POPLAR STREET
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
ROSLINDALE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02131-4302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-323-2276
Provider Business Practice Location Address Fax Number:
617-323-2294
Provider Enumeration Date:
01/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PENTOCOSTER
Authorized Official First Name:
TEKUM
Authorized Official Middle Name:
FOMUM
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
617-323-2276

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  7373 , 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)

  • Identifier: 7373 . This is a "MA PERSONAL CARE, HOMEMAKER LICENSE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com