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General NPI Number Information
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NPI Number | 1790771426
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Entity Type | Organization
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Legal Business Name | FAMILY REHABILITATION SERVICES, INC.
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 133 HANCOCK ST
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City | DORCHESTER
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State | MA
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Zip | 02125-2136
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Country | US
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Telephone | 617-265-5221
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Fax |
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Provider Business Mailing Address
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Address Line | 133 HANCOCK ST
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City | DORCHESTER
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State | MA
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Zip | 02125-2136
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Country | US
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Telephone | 617-265-5221
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. GEORGE GOUGIAN
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Credential |
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Telephone | 617-265-5221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 0465
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License Number State | MA
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