Healthcare Provider Details

I. General information

NPI: 1073016705
Provider Name (Legal Business Name): NORTH SHORE UNITED HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 03/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 HIGHLAND AVE UNIT 1107
SALEM MA
01970-2743
US

IV. Provider business mailing address

205 HIGHLAND AVE UNIT 1107
SALEM MA
01970-2743
US

V. Phone/Fax

Practice location:
  • Phone: 857-364-9645
  • Fax:
Mailing address:
  • Phone: 857-364-9645
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: THERESE PELAGIE BONOK
Title or Position: MANAGER
Credential: RN, BSN.
Phone: 978-259-8534