Healthcare Provider Details

I. General information

NPI: 1063415602
Provider Name (Legal Business Name): SERAPHIC SPRINGS HEALTH CARE AGENCY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 WESTERN AVE
LYNN MA
01904-3317
US

IV. Provider business mailing address

425 WESTERN AVE
LYNN MA
01904-3317
US

V. Phone/Fax

Practice location:
  • Phone: 781-780-6515
  • Fax: 781-593-3618
Mailing address:
  • Phone: 781-780-6515
  • Fax: 781-593-3618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number227446
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number227446
License Number StateMA

VIII. Authorized Official

Name: MS. FOLUSO OMOTOLA OLUBANJO
Title or Position: ADMINISTRATOR/OWNER
Credential:
Phone: 781-780-6515