Healthcare Provider Details

I. General information

NPI: 1215246020
Provider Name (Legal Business Name): HOMEFRONT MERRIMACK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 MERRIMACK ST
LAWRENCE MA
01843-1754
US

IV. Provider business mailing address

121 LORING AVE SUITE 820
SALEM MA
01970-4461
US

V. Phone/Fax

Practice location:
  • Phone: 978-745-8505
  • Fax: 978-745-8503
Mailing address:
  • Phone: 978-745-8505
  • Fax: 978-745-8503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. RICHARD C BANE
Title or Position: PRESIDENT/CEO
Credential:
Phone: 978-745-8505