Healthcare Provider Details

I. General information

NPI: 1407328305
Provider Name (Legal Business Name): GOKUL ADULT DAY CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 FROST RD
TYNGSBORO MA
01879-1105
US

IV. Provider business mailing address

45 KATHERINE DR
LOWELL MA
01854-1135
US

V. Phone/Fax

Practice location:
  • Phone: 978-884-2642
  • Fax:
Mailing address:
  • Phone: 978-884-2642
  • Fax:

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: NIRANJAN BHAGAT
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 978-884-2642