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General NPI Number Information
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NPI Number | 1164814497
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Entity Type | Organization
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Legal Business Name | PRIVATE HOME CARE
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Dates
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Enumeration Date | 02/24/2015
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Last Update Date | 02/24/2015
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Provider Practice Location Address
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Address Line | 183 PLEASANT ST
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City | MARBLEHEAD
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State | MA
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Zip | 01945-2337
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Country | US
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Telephone | 781-693-8696
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Fax |
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Provider Business Mailing Address
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Address Line | 183 PLEASANT ST
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City | MARBLEHEAD
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State | MA
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Zip | 01945-2337
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Country | US
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Telephone | 781-693-8696
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & RN
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Name | MRS. MARY MACARY DEMAKES
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Credential | RN
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Telephone | 781-639-8696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 126965
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License Number State | MA
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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 | 8002
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License Number State | MA
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