=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477839132
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATRIOT ELDER CARE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2011
-----------------------------------------------------
Last Update Date | 12/14/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1261 FURNACE BROOK PARKWAY SUITE 22
-----------------------------------------------------
City | QUINCY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02169
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-302-2481
-----------------------------------------------------
Fax | 617-472-6947
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1261 FURNACE BROOK PARKWAY SUITE 22
-----------------------------------------------------
City | QUINCY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02169
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-302-2481
-----------------------------------------------------
Fax | 617-472-6947
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | SCOTT ANDREWS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 617-479-4545
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 313M00000X
-----------------------------------------------------
Taxonomy Name | Nursing Facility/Intermediate Care Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 313M00000X
-----------------------------------------------------
Taxonomy Name | Nursing Facility/Intermediate Care Facility
-----------------------------------------------------
License Number | 4SVE
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------