Healthcare Provider Details

I. General information

NPI: 1598215998
Provider Name (Legal Business Name): IDEAL CAREGIVERS OF MASSACHUSETTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 STATE ST SUIT 502
SPRINGFIELD MA
01103-1984
US

IV. Provider business mailing address

115 STATE ST SUIT 502
SPRINGFIELD MA
01103-1984
US

V. Phone/Fax

Practice location:
  • Phone: 413-306-8605
  • Fax:
Mailing address:
  • Phone: 413-306-8605
  • 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 Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS PAMELA JUMBA
Title or Position: OWNER
Credential:
Phone: 413-306-8605