Healthcare Provider Details

I. General information

NPI: 1346668605
Provider Name (Legal Business Name): STOUGHTON ADULT MEDICAL DAY CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

966 PARK ST BLDG B SUITE B1
STOUGHTON MA
02072-3650
US

IV. Provider business mailing address

966 PARK ST BLDG B
STOUGHTON MA
02072-3650
US

V. Phone/Fax

Practice location:
  • Phone: 508-586-2222
  • Fax: 508-586-2212
Mailing address:
  • Phone: 508-586-2222
  • Fax: 508-586-2212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICHELLE A BODOIN
Title or Position: PROGRAM DIRECTOR
Credential: P.T.A., PD
Phone: 508-586-2222