Healthcare Provider Details

I. General information

NPI: 1679458376
Provider Name (Legal Business Name): RESPIRO AZUL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 MAIN ST
INDIAN ORCHARD MA
01151-1222
US

IV. Provider business mailing address

518 MAIN ST
INDIAN ORCHARD MA
01151-1222
US

V. Phone/Fax

Practice location:
  • Phone: 413-777-8516
  • Fax:
Mailing address:
  • Phone: 413-777-8516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SELENIA INDHIRA BOBADILLA
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 413-777-8516