=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407263684
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TODUMBRELLA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2014
-----------------------------------------------------
Last Update Date | 07/19/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 73 LEXINGTON ST LL5
-----------------------------------------------------
City | AUBURNDALE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02466-1356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-792-0500
-----------------------------------------------------
Fax | 617-213-5457
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 73 LEXINGTON ST LL5
-----------------------------------------------------
City | AUBURNDALE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02466-1356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-792-0500
-----------------------------------------------------
Fax | 617-213-5457
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | COLLINS O EMERHI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 617-319-1502
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | T3LV
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------