Healthcare Provider Details

I. General information

NPI: 1750143384
Provider Name (Legal Business Name): 1190 ADAMS OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 ADAMS ST
BOSTON MA
02124-5772
US

IV. Provider business mailing address

4500 DORR ST
TOLEDO OH
43615-4040
US

V. Phone/Fax

Practice location:
  • Phone: 617-298-5656
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. SHARON MAKOWSKY
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 419-247-2800