MEDICARE: SERAPHIC SPRINGS HEALTH CARE AGENCY, INC.

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	251E00000X	Home Health Agency	227446	ME
2	251E00000X	Home Health Agency	227446	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	110024476A	OTHER	MA	MASSHEALTH

General Provider Information

NPI Number	:	1063415602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERAPHIC SPRINGS HEALTH CARE AGENCY, INC.

Provider Business Mailing Address
First Line	:	425 WESTERN AVE
Second Line	:
City	:	LYNN
State	:	MA
Zip	:	01904-3317
Country	:	US
Telephone Number	:	781-780-6515
Fax Number	:	781-593-3618

Provider Business Practice Location Address
First Line	:	425 WESTERN AVE
Second Line	:
City	:	LYNN
State	:	MA
Zip	:	01904-3317
Country	:	US
Telephone Number	:	781-780-6515
Fax Number	:	781-593-3618

Authorized Official
Title or Position	:	ADMINISTRATOR/OWNER
Name	:	MS. FOLUSO OMOTOLA OLUBANJO
Credential	:
Telephone Number	:	781-780-6515

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	10/20/2015

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Directions to “SERAPHIC SPRINGS HEALTH CARE AGENCY, INC. ” Practice Location

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