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General NPI Number Information
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NPI Number | 1225469224
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Entity Type | Organization
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Legal Business Name | GISSLENE HOME HEALTH AIDE AGENCY LLC
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Dates
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Enumeration Date | 12/02/2013
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Last Update Date | 12/02/2013
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Provider Practice Location Address
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Address Line | 54 WARREN AVE
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City | HYDE PARK
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State | MA
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Zip | 02136-3533
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Country | US
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Telephone | 617-333-9479
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Fax |
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Provider Business Mailing Address
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Address Line | 54 WARREN AVE
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City | HYDE PARK
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State | MA
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Zip | 02136
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GISSELENE BEAUPLANT
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Credential |
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Telephone | 617-333-9479
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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 | 193200000X
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License Number State | MA
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