Healthcare Provider Details

I. General information

NPI: 1316093339
Provider Name (Legal Business Name): ZABOTA COMMUNITY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 N COMMON ST
LYNN MA
01905-2547
US

IV. Provider business mailing address

191 N COMMON ST
LYNN MA
01905-2547
US

V. Phone/Fax

Practice location:
  • Phone: 781-595-3200
  • Fax: 781-595-3207
Mailing address:
  • Phone: 781-595-3200
  • Fax: 781-595-3207

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: GENNADIY ITSKIN
Title or Position: DIRECTOR
Credential:
Phone: 781-595-3200