Healthcare Provider Details

I. General information

NPI: 1841712981
Provider Name (Legal Business Name): EVERGREEN ADULT DAY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 12/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 COMMONWEALTH AVE
WOBURN MA
01801-5193
US

IV. Provider business mailing address

5 KING ARTHUR RD
SHREWSBURY MA
01545-7750
US

V. Phone/Fax

Practice location:
  • Phone: 774-245-0727
  • Fax:
Mailing address:
  • Phone: 774-245-0727
  • 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: MRS. RACHANA SHAH
Title or Position: PRESIDENT
Credential:
Phone: 774-245-0727