Healthcare Provider Details

I. General information

NPI: 1215560347
Provider Name (Legal Business Name): LUNA ADULT DAY HEALTH CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 HAMMOND ST
WORCESTER MA
01610-1513
US

IV. Provider business mailing address

18 HAMMOND ST
WORCESTER MA
01610-1513
US

V. Phone/Fax

Practice location:
  • Phone: 508-873-5048
  • Fax: 508-519-6211
Mailing address:
  • Phone: 508-873-5048
  • Fax: 508-873-5048

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: SEHILA R RYERSON
Title or Position: CEO/PROGRAM DIRECTOR
Credential:
Phone: 508-873-5048