Healthcare Provider Details

I. General information

NPI: 1033599428
Provider Name (Legal Business Name): NILE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 06/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MIDDLESEX RD #2
WALTHAM MA
02452-6171
US

IV. Provider business mailing address

15 MIDDLESEX RD #2
WALTHAM MA
02452-6171
US

V. Phone/Fax

Practice location:
  • Phone: 617-669-1789
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2264775
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number2270963
License Number StateMA

VIII. Authorized Official

Name: ANGELLA BURNS
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 617-669-1789