Healthcare Provider Details

I. General information

NPI: 1396004982
Provider Name (Legal Business Name): PIONEER VALLEY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 HARTWELL ST
WEST BOYLSTON MA
01583-2409
US

IV. Provider business mailing address

125 HARTWELL ST
WEST BOYLSTON MA
01583-2409
US

V. Phone/Fax

Practice location:
  • Phone: 508-835-2800
  • Fax: 508-835-2899
Mailing address:
  • Phone: 508-835-2800
  • Fax: 508-835-2899

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. NADIA ZABARSKAYA
Title or Position: MANAGING PARTNER
Credential:
Phone: 508-835-2800