Healthcare Provider Details

I. General information

NPI: 1407346836
Provider Name (Legal Business Name): CANTON ADH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 TURNPIKE ST
CANTON MA
02021-2704
US

IV. Provider business mailing address

6 MCENELLY CIR
RANDOLPH MA
02368-3672
US

V. Phone/Fax

Practice location:
  • Phone: 617-930-4637
  • Fax:
Mailing address:
  • Phone: 617-930-4637
  • 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: EMMANUELLE RENELIQUE
Title or Position: OWNER
Credential:
Phone: 617-930-4637