Healthcare Provider Details

I. General information

NPI: 1376600569
Provider Name (Legal Business Name): ROGERSON COMMUNITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2053R COLUMBUS AVENUE
ROXBURY MA
02119
US

IV. Provider business mailing address

2053R COLUMBUS AVENUE
ROXBURY MA
02119
US

V. Phone/Fax

Practice location:
  • Phone: 617-469-5800
  • Fax:
Mailing address:
  • Phone: 617-469-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateMA

VIII. Authorized Official

Name: MATT PICCARINI JR.
Title or Position: FINANCIAL PERFORMANCE MANAGER
Credential:
Phone: 617-463-5836