MEDICARE: ALPHACARE HOME HEALTH 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	253J00000X	Foster Care Agency
2	251E00000X	Home Health Agency		MA

General Provider Information

NPI Number	:	1770808636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHACARE HOME HEALTH AGENCY INC

Provider Business Mailing Address
First Line	:	214 LINCOLN ST
Second Line	:	SUITE 304
City	:	ALLSTON
State	:	MA
Zip	:	02134-1347
Country	:	US
Telephone Number	:	617-600-4547
Fax Number	:

Provider Business Practice Location Address
First Line	:	214 LINCOLN ST
Second Line	:	SUITE 304
City	:	ALLSTON
State	:	MA
Zip	:	02134-1347
Country	:	US
Telephone Number	:	617-600-4547
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. ANTON I PUKHOVITSKY
Credential	:
Telephone Number	:	617-600-4547

Provider Enumeration Date	:	04/05/2010
Last Update Date	:	01/18/2012

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