Healthcare Provider Details

I. General information

NPI: 1275921900
Provider Name (Legal Business Name): ABJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 COOLIDGE RD
WORCESTER MA
01602-2750
US

IV. Provider business mailing address

99 COOLIDGE RD
WORCESTER MA
01602-2750
US

V. Phone/Fax

Practice location:
  • Phone: 508-756-8065
  • Fax: 774-823-3351
Mailing address:
  • Phone: 508-756-8065
  • Fax: 774-823-3351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number8427
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8427
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerLICENSE

VIII. Authorized Official

Name: MRS. JOLANTA KAMINSKA
Title or Position: MANAGER
Credential:
Phone: 508-756-8065