Healthcare Provider Details

I. General information

NPI: 1154663094
Provider Name (Legal Business Name): SULLY HOME CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 MEMORIAL DR
AVON MA
02322-1918
US

IV. Provider business mailing address

145 HIGH ST
RANDOLPH MA
02368-2729
US

V. Phone/Fax

Practice location:
  • Phone: 617-212-6527
  • Fax: 781-885-7483
Mailing address:
  • Phone: 617-212-6527
  • Fax: 781-885-7483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: OSMAN ERMANN SULLY
Title or Position: VP
Credential:
Phone: 508-510-6963