Healthcare Provider Details

I. General information

NPI: 1649947748
Provider Name (Legal Business Name): HEALTHY LIVING ORGANIZATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 BEACH ST APT 3
QUINCY MA
02170-2857
US

IV. Provider business mailing address

24 BEACH ST APT 3
QUINCY MA
02170-2857
US

V. Phone/Fax

Practice location:
  • Phone: 781-654-5522
  • Fax:
Mailing address:
  • Phone: 781-654-5522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code282J00000X
TaxonomyReligious Nonmedical Health Care Institution
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: NICK KRASILNIKOV SR.
Title or Position: PRESIDENT
Credential: ND
Phone: 781-654-5522