Healthcare Provider Details

I. General information

NPI: 1467805184
Provider Name (Legal Business Name): QUILNINIOUS RANDALL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3313 WASHINGTON ST
BOSTON MA
02130-2691
US

IV. Provider business mailing address

3313 WASHINGTON ST
BOSTON MA
02130-2691
US

V. Phone/Fax

Practice location:
  • Phone: 508-789-2365
  • Fax:
Mailing address:
  • Phone: 508-789-2365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: