Healthcare Provider Details

I. General information

NPI: 1982177655
Provider Name (Legal Business Name): DIA FELIZ ADHC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2019
Last Update Date: 01/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 FOUNTAIN ST
FRAMINGHAM MA
01702-6279
US

IV. Provider business mailing address

63 FOUNTAIN ST
FRAMINGHAM MA
01702-6279
US

V. Phone/Fax

Practice location:
  • Phone: 508-270-1080
  • Fax:
Mailing address:
  • Phone: 508-270-1080
  • 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: MR. ALLON GUSEYNOV
Title or Position: MANAGING MEMBER
Credential:
Phone: 617-504-1400