MEDICARE: DUCHARME ESTATES LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	1904787	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1904787	OTHER	MA	MA. PROVIDER NUMBER

General Provider Information

NPI Number	:	1003934928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUCHARME ESTATES LTD

Provider Business Mailing Address
First Line	:	25 FEDERAL ST
Second Line	:
City	:	BLACKSTONE
State	:	MA
Zip	:	01504-1327
Country	:	US
Telephone Number	:	508-883-2066
Fax Number	:	508-883-0360

Provider Business Practice Location Address
First Line	:	25 FEDERAL ST
Second Line	:
City	:	BLACKSTONE
State	:	MA
Zip	:	01504-1327
Country	:	US
Telephone Number	:	508-883-2066
Fax Number	:	508-883-0360

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. MARCIA DEMELO-DUCHARME
Credential	:	M.ED. MB.ADM.
Telephone Number	:	508-883-2066

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	08/22/2020

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