Provider Demographics
NPI:1609053586
Name:PRIORITY HOME CARE SERVICES
Entity type:Organization
Organization Name:PRIORITY HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TEKUM
Authorized Official - Middle Name:FOMUM
Authorized Official - Last Name:PENTOCOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-323-2276
Mailing Address - Street 1:17 POPLAR ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-2505
Mailing Address - Country:US
Mailing Address - Phone:617-323-2276
Mailing Address - Fax:617-323-2494
Practice Address - Street 1:17 POPLAR STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-4302
Practice Address - Country:US
Practice Address - Phone:617-323-2276
Practice Address - Fax:617-323-2294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7373251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7373OtherMA PERSONAL CARE, HOMEMAKER LICENSE
MA7373OtherMA PERSONAL CARE, HOMEMAKER LICENSE