Healthcare Provider Details

I. General information

NPI: 1144041674
Provider Name (Legal Business Name): MAYOLA HOME CARE SERVICE OF NORTH SHORE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 LYNNFIELD ST
LYNN MA
01904-2222
US

IV. Provider business mailing address

68 HARRISON AVE STE 605
BOSTON MA
02111-1929
US

V. Phone/Fax

Practice location:
  • Phone: 781-299-3667
  • Fax:
Mailing address:
  • Phone: 978-347-2466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MS. YOUM MAYOLA
Title or Position: CEO
Credential:
Phone: 781-299-3667