Healthcare Provider Details

I. General information

NPI: 1013464536
Provider Name (Legal Business Name): INTECLINCO HOME HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 MILLSTONE RD APT. 2
HYDE PARK MA
02136-2309
US

IV. Provider business mailing address

PO BOX 120-872
BOSTON MA
02112-2309
US

V. Phone/Fax

Practice location:
  • Phone: 857-334-4186
  • Fax:
Mailing address:
  • Phone: 857-334-4186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JENEPHER JUDITH NALYANYA
Title or Position: DIRECTOR
Credential: MD,MPH, MS, BSN
Phone: 407-409-9128