Healthcare Provider Details

I. General information

NPI: 1407220304
Provider Name (Legal Business Name): LADY OF FATIMA HOMECARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 PLEASANT ST
DRACUT MA
01826-4817
US

IV. Provider business mailing address

207 PLEASANT ST
DRACUT MA
01826-4817
US

V. Phone/Fax

Practice location:
  • Phone: 978-609-4016
  • Fax: 978-957-9698
Mailing address:
  • Phone: 978-609-4016
  • Fax: 978-957-9698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number001190136
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number001190136
License Number StateMA

VIII. Authorized Official

Name: FATIMA JAITEH
Title or Position: FOUNDER/CEO
Credential:
Phone: 978-609-4016