Healthcare Provider Details

I. General information

NPI: 1164814497
Provider Name (Legal Business Name): PRIVATE HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2015
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 PLEASANT ST
MARBLEHEAD MA
01945-2337
US

IV. Provider business mailing address

183 PLEASANT ST
MARBLEHEAD MA
01945-2337
US

V. Phone/Fax

Practice location:
  • Phone: 781-693-8696
  • Fax:
Mailing address:
  • Phone: 781-693-8696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number8002
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number126965
License Number StateMA

VIII. Authorized Official

Name: MRS. MARY MACARY DEMAKES
Title or Position: PRESIDENT & RN
Credential: RN
Phone: 781-639-8696