Healthcare Provider Details

I. General information

NPI: 1740792852
Provider Name (Legal Business Name): VATRA ADHC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2017
Last Update Date: 10/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MESSINA DR
BRAINTREE MA
02184-6704
US

IV. Provider business mailing address

50 MESSINA DR
BRAINTREE MA
02184-6704
US

V. Phone/Fax

Practice location:
  • Phone: 617-877-9126
  • Fax:
Mailing address:
  • Phone: 617-877-9126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AGRON GJERASI
Title or Position: ADMINISTRATOR
Credential:
Phone: 617-877-9126