Healthcare Provider Details

I. General information

NPI: 1376054189
Provider Name (Legal Business Name): SOUTHEASTERN MASSACHUSETTS HOME HEALTH AIDES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MORGAN ST
FALL RIVER MA
02721-1991
US

IV. Provider business mailing address

101 MORGAN ST
FALL RIVER MA
02721-1991
US

V. Phone/Fax

Practice location:
  • Phone: 508-672-5519
  • Fax: 508-324-0875
Mailing address:
  • Phone: 508-672-5519
  • Fax: 508-324-0875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier110104738
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerMASSHEALTH

VIII. Authorized Official

Name: AMY TOBIN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 508-672-5519