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General NPI Number Information
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NPI Number | 1679615330
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Entity Type | Organization
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Legal Business Name | STAY WELL AHDC, INC.
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 45 CONGRESS ST
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City | SALEM
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State | MA
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Zip | 01970-5579
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Country | US
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Telephone | 978-825-0202
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Fax |
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Provider Business Mailing Address
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Address Line | 45 CONGRESS ST
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City | SALEM
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State | MA
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Zip | 01970-5579
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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 | PROGRAM DIRECTOR
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Name | MRS. STELLA KREMENCHUGSKY
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Credential |
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Telephone | 781-718-8472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 1904591
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License Number State | MA
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