Healthcare Provider Details

I. General information

NPI: 1861662017
Provider Name (Legal Business Name): ATHENA NURSING PLACEMENT JOINT VENTURE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 RIVERSIDE DR STE 201
LAKEVILLE MA
02347-1689
US

IV. Provider business mailing address

10 RIVERSIDE DR STE 201
LAKEVILLE MA
02347-1689
US

V. Phone/Fax

Practice location:
  • Phone: 508-673-5500
  • Fax: 508-673-6500
Mailing address:
  • Phone: 508-673-5500
  • Fax: 508-673-6500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMA

VIII. Authorized Official

Name: LAWRENCE G. SANTILLI
Title or Position: MANAGER
Credential:
Phone: 860-751-3900