=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093355083
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NAAFAY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2020
-----------------------------------------------------
Last Update Date | 01/08/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 265 BEAR HILL RD
-----------------------------------------------------
City | NORTH ANDOVER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01845-2115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-640-4720
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 265 BEAR HILL RD
-----------------------------------------------------
City | NORTH ANDOVER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01845-2115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-640-4720
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JUDITH FOKUM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 781-640-4720
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------