Healthcare Provider Details

I. General information

NPI: 1669462826
Provider Name (Legal Business Name): LIFE CARE AT HOME OF MASSACHUSETTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 STEVENS ST
EAST TAUNTON MA
02718-1319
US

IV. Provider business mailing address

3001 KEITH ST NW
CLEVELAND TN
37312-3713
US

V. Phone/Fax

Practice location:
  • Phone: 508-822-6066
  • Fax: 508-822-9820
Mailing address:
  • Phone: 423-473-5256
  • Fax: 423-339-8356

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: PAMELA RAU
Title or Position: VP OF FINANCE
Credential:
Phone: 423-473-5280