Healthcare Provider Details

I. General information

NPI: 1548681182
Provider Name (Legal Business Name): AWAKENING EXCELLENCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2013
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208A VFW PKWY SUITE 7
WEST ROXBURY MA
02132-4338
US

IV. Provider business mailing address

6 MCENELLY CIR
RANDOLPH MA
02368-3672
US

V. Phone/Fax

Practice location:
  • Phone: 617-930-4637
  • Fax:
Mailing address:
  • Phone: 617-930-4637
  • 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: EMMANUELLE RENELIQUE
Title or Position: OWNER
Credential:
Phone: 617-930-4637