Healthcare Provider Details

I. General information

NPI: 1790640472
Provider Name (Legal Business Name): PROXIMA HEALTHCARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 GLEN ROAD
WILMINGTON MA
01887
US

IV. Provider business mailing address

703 GLEN ROAD
WILMINGTON MA
01887
US

V. Phone/Fax

Practice location:
  • Phone: 781-513-0604
  • Fax:
Mailing address:
  • Phone: 781-513-0604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BLAIN SIMEON
Title or Position: MANAGER
Credential:
Phone: 781-513-0604