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General NPI Number Information
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NPI Number | 1861021818
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Entity Type | Organization
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Legal Business Name | VITRA GAFC, LLC
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Dates
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Enumeration Date | 04/02/2020
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Last Update Date | 04/02/2020
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Provider Practice Location Address
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Address Line | 150 WOOD RD STE 201
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City | BRAINTREE
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State | MA
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Zip | 02184-2510
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Country | US
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Telephone | 508-297-2022
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Fax | 508-689-7848
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Provider Business Mailing Address
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Address Line | 150 WOOD RD STE 201
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City | BRAINTREE
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State | MA
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Zip | 02184-2510
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Country | US
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Telephone | 508-297-2022
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Fax | 508-689-7848
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Authorized Official
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Title or Position | COO
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Name | EDWARD SPIVAK
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Credential |
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Telephone | 508-594-8288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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