Healthcare Provider Details

I. General information

NPI: 1629880299
Provider Name (Legal Business Name): ANNA BISSONNETTE HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 WASHINGTON ST
BOSTON MA
02118-3380
US

IV. Provider business mailing address

1640 WASHINGTON ST
BOSTON MA
02118-3380
US

V. Phone/Fax

Practice location:
  • Phone: 617-369-1557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ANDREW COLE
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 617-369-1557