Healthcare Provider Details

I. General information

NPI: 1154954311
Provider Name (Legal Business Name): ZDOROVIE COMMUNITY CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 CALIFORNIA ST
NEWTON MA
02458-1023
US

IV. Provider business mailing address

143 CALIFORNIA ST
NEWTON MA
02458-1023
US

V. Phone/Fax

Practice location:
  • Phone: 617-795-0668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: BAUDY MAZAEV
Title or Position: CFO
Credential:
Phone: 857-488-2399