Healthcare Provider Details

I. General information

NPI: 1740070291
Provider Name (Legal Business Name): FUENTES COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 MERRIAM AVE STE 201
LEOMINSTER MA
01453-3158
US

IV. Provider business mailing address

59 MERRIAM AVE STE 201
LEOMINSTER MA
01453-3158
US

V. Phone/Fax

Practice location:
  • Phone: 774-530-1938
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. KEVIN KARANJA
Title or Position: OWNER
Credential: MAT
Phone: 774-530-1938