Healthcare Provider Details

I. General information

NPI: 1831022797
Provider Name (Legal Business Name): MRS. ROSE EBUDE MCKIBBEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

370 MERRIMACK ST STE 250
LAWRENCE MA
01843-1789
US

IV. Provider business mailing address

370 MERRIMACK ST STE 250
LAWRENCE MA
01843-1789
US

V. Phone/Fax

Practice location:
  • Phone: 978-984-7791
  • Fax: 978-682-2160
Mailing address:
  • Phone: 978-984-7791
  • Fax: 978-682-2160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: