Healthcare Provider Details

I. General information

NPI: 1760866065
Provider Name (Legal Business Name): MASS GENERAL BRIGHAM HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 01/21/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 WELLS AVE STE 320
NEWTON MA
02459-3216
US

IV. Provider business mailing address

95 WELLS AVE STE 320
NEWTON MA
02459-3216
US

V. Phone/Fax

Practice location:
  • Phone: 781-290-4000
  • Fax: 781-290-4050
Mailing address:
  • Phone: 781-290-4000
  • Fax: 781-290-4050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KEREN DIAMOND
Title or Position: VICE PRESIDENT AND COO
Credential:
Phone: 781-290-4000