Healthcare Provider Details

I. General information

NPI: 1689538274
Provider Name (Legal Business Name): PRIMEMED HEALTHCARE SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BAYBERRY RD
CANTON MA
02021-2461
US

IV. Provider business mailing address

10 BAYBERRY RD
CANTON MA
02021-2461
US

V. Phone/Fax

Practice location:
  • Phone: 617-548-1422
  • Fax:
Mailing address:
  • Phone: 617-548-1422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NEPHTALIE G RENELIQUE
Title or Position: OWNER
Credential: APRN, PMHNP-BC, FNP
Phone: 617-548-1422