Healthcare Provider Details

I. General information

NPI: 1275832867
Provider Name (Legal Business Name): ENRICHED ADULT DAY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2011
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 COLUMBIA ROAD UNIT 600
HANOVER MA
02339
US

IV. Provider business mailing address

409 COLUMBIA ROAD UNIT 600
HANOVER MA
02339
US

V. Phone/Fax

Practice location:
  • Phone: 781-524-1688
  • Fax: 781-524-1657
Mailing address:
  • Phone: 781-524-1688
  • Fax: 781-524-1657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberRN261124
License Number StateMA

VIII. Authorized Official

Name: MRS. NEREE THEMISTOCLE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 774-444-6389