Healthcare Provider Details

I. General information

NPI: 1992663710
Provider Name (Legal Business Name): SHAMMAH HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1047 SOUTHERN ARTERY APT 602
QUINCY MA
02169-8305
US

IV. Provider business mailing address

500 GROSSMAN DR # 1259
BRAINTREE MA
02184-4967
US

V. Phone/Fax

Practice location:
  • Phone: 617-588-3509
  • Fax:
Mailing address:
  • Phone: 617-588-3509
  • 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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: NINFO LARE
Title or Position: CEO
Credential: RN
Phone: 617-588-3509