Healthcare Provider Details

I. General information

NPI: 1902192537
Provider Name (Legal Business Name): LAMOUR BY DESIGN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N MAIN ST STE A
RANDOLPH MA
02368-6700
US

IV. Provider business mailing address

1215 WARREN AVE #2REAR
BROCKTON MA
02301-6856
US

V. Phone/Fax

Practice location:
  • Phone: 774-444-4916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. GUAN QUATEZ' ELLERBE
Title or Position: SOCIAL WORKER
Credential:
Phone: 774-444-4916