Healthcare Provider Details

I. General information

NPI: 1215384557
Provider Name (Legal Business Name): BANE HANCOCK PARK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 07/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 PARKINGWAY
QUINCY MA
02169-5020
US

IV. Provider business mailing address

52 ACCORD PARK DR
NORWELL MA
02061-1628
US

V. Phone/Fax

Practice location:
  • Phone: 617-773-4222
  • Fax:
Mailing address:
  • Phone: 781-878-6700
  • Fax: 781-878-9807

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: MR. HARRISON BANE
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential:
Phone: 781-878-6700