Healthcare Provider Details

I. General information

NPI: 1417591892
Provider Name (Legal Business Name): ILENA MARIE ARRUDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 N MAIN ST STE 205
FALL RIVER MA
02720-2972
US

IV. Provider business mailing address

23 AMES BAKER WAY
DARTMOUTH MA
02748-1109
US

V. Phone/Fax

Practice location:
  • Phone: 508-324-0328
  • Fax:
Mailing address:
  • Phone: 774-929-5661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: