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General NPI Number Information
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NPI Number | 1336083559
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Entity Type | Organization
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Legal Business Name | LSE PHV LLC
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Dates
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Enumeration Date | 04/17/2026
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Last Update Date | 04/17/2026
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Provider Practice Location Address
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Address Line | 46 LINCOLN ST
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City | WINTHROP
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State | MA
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Zip | 02152-2151
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Country | US
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Telephone | 612-207-3009
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Fax |
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Provider Business Mailing Address
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Address Line | 46 LINCOLN ST
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City | WINTHROP
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State | MA
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Zip | 02152-2151
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Country | US
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Telephone | 612-207-3009
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DARLEY NAZAIRE
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Credential |
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Telephone | 612-207-3009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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