Healthcare Provider Details

I. General information

NPI: 1306707856
Provider Name (Legal Business Name): ME LA VANG COMMUNITY HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2025
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N MAIN ST STE A
RANDOLPH MA
02368-2121
US

IV. Provider business mailing address

1101 N MAIN ST STE A
RANDOLPH MA
02368-2121
US

V. Phone/Fax

Practice location:
  • Phone: 781-807-8093
  • Fax:
Mailing address:
  • Phone: 781-807-8093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: LINA NGUYEN
Title or Position: PROGRAM ADMINISTRATOR
Credential:
Phone: 781-807-8093