Healthcare Provider Details

I. General information

NPI: 1194966929
Provider Name (Legal Business Name): CLASSIC HOME CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 03/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 JACKSON ST
SALEM MA
01970-3068
US

IV. Provider business mailing address

92 JACKSON ST
SALEM MA
01970-3068
US

V. Phone/Fax

Practice location:
  • Phone: 978-741-2000
  • Fax: 978-741-2009
Mailing address:
  • Phone: 978-741-2000
  • Fax: 978-741-2009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7431
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number7431
License Number StateMA

VIII. Authorized Official

Name: ELIZABETH THERESA OSBAHR
Title or Position: PRESIDENT
Credential: RN
Phone: 978-741-2000