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General NPI Number Information
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NPI Number | 1346237757
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Entity Type | Organization
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Legal Business Name | MARY IMMACULATE ADULT DAY HEALTH CENTER, INC.
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Dates
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Enumeration Date | 09/30/2005
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Last Update Date | 08/06/2008
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Provider Practice Location Address
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Address Line | 189 MAPLE ST
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City | LAWRENCE
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State | MA
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Zip | 01841-3761
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Country | US
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Telephone | 978-682-7575
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Fax | 978-691-5374
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Provider Business Mailing Address
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Address Line | 172 LAWRENCE ST
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City | LAWRENCE
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State | MA
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Zip | 01841-3849
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Country | US
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Telephone | 978-685-6321
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Fax | 978-975-0050
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | MS. BARBARA E. GRANT
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Credential |
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Telephone | 978-685-6321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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