Healthcare Provider Details

I. General information

NPI: 1841702305
Provider Name (Legal Business Name): RELIANT HEALTH SYSTEMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 SHREWSBURY ST
WORCESTER MA
01604-1632
US

IV. Provider business mailing address

377 SHREWSBURY ST
WORCESTER MA
01604-1632
US

V. Phone/Fax

Practice location:
  • Phone: 774-239-4062
  • Fax:
Mailing address:
  • Phone: 774-239-4062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: BRIAN KASIRYE SERWANIKO
Title or Position: CO-FOUNDER
Credential:
Phone: 774-239-4062