Healthcare Provider Details

I. General information

NPI: 1700212545
Provider Name (Legal Business Name): LA BELLA VIDA ADULT DAY HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 BUTTERCUP LN
DOVER MA
02030-2005
US

IV. Provider business mailing address

11 BUTTERCUP LN
DOVER MA
02030-2005
US

V. Phone/Fax

Practice location:
  • Phone: 617-921-1041
  • Fax:
Mailing address:
  • Phone:
  • 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: DANNY BINDER
Title or Position: CEO
Credential:
Phone: 617-921-1041