Healthcare Provider Details

I. General information

NPI: 1912290081
Provider Name (Legal Business Name): MARY IMMACULATE ADULT DAY HEALTH II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 MAPLE ST
LAWRENCE MA
01841-3763
US

IV. Provider business mailing address

172 LAWRENCE ST
LAWRENCE MA
01841-3849
US

V. Phone/Fax

Practice location:
  • Phone: 978-682-7575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: MS. BARBARA GRANT
Title or Position: PRESIDENT / CEO
Credential:
Phone: 978-685-6321