Healthcare Provider Details

I. General information

NPI: 1861730715
Provider Name (Legal Business Name): FAMILY CAREGIVERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2013
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

891 CENTRE ST
JAMAICA PLAIN MA
02130-2776
US

IV. Provider business mailing address

891 CENTRE ST
JAMAICA PLAIN MA
02130-2776
US

V. Phone/Fax

Practice location:
  • Phone: 617-477-8290
  • Fax: 617-477-8292
Mailing address:
  • Phone: 617-522-0630
  • Fax: 617-477-8292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JOSE A DE LA ROSA
Title or Position: CEO
Credential:
Phone: 617-477-8290