Healthcare Provider Details

I. General information

NPI: 1760164461
Provider Name (Legal Business Name): 81 HEALTH AND WELLNESS HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 BEAUFORD LN
BOSTON MA
02125-3070
US

IV. Provider business mailing address

3 BEAUFORD LN
BOSTON MA
02125-3070
US

V. Phone/Fax

Practice location:
  • Phone: 617-230-9946
  • Fax:
Mailing address:
  • Phone: 617-230-9946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: ADETOUN OKENLA
Title or Position: SOLE PROPRIETOR
Credential: NP
Phone: 617-230-9946