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General NPI Number Information
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NPI Number | 1063415602
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Entity Type | Organization
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Legal Business Name | SERAPHIC SPRINGS HEALTH CARE AGENCY, INC.
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 10/20/2015
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Provider Practice Location Address
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Address Line | 425 WESTERN AVE
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City | LYNN
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State | MA
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Zip | 01904-3317
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Country | US
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Telephone | 781-780-6515
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Fax | 781-593-3618
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Provider Business Mailing Address
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Address Line | 425 WESTERN AVE
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City | LYNN
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State | MA
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Zip | 01904-3317
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Country | US
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Telephone | 781-780-6515
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Fax | 781-593-3618
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | MS. FOLUSO OMOTOLA OLUBANJO
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Credential |
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Telephone | 781-780-6515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 227446
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 227446
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License Number State | MA
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