Provider Demographics
NPI:1871949545
Name:IMMACULATE HOMECARE SERVICES
Entity type:Organization
Organization Name:IMMACULATE HOMECARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GATHINGU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:781-787-0993
Mailing Address - Street 1:800 W CUMMINGS PARK STE 1400
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-6374
Mailing Address - Country:US
Mailing Address - Phone:781-281-8078
Mailing Address - Fax:781-998-0228
Practice Address - Street 1:800 W CUMMINGS PARK STE 1400
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6374
Practice Address - Country:US
Practice Address - Phone:781-281-8078
Practice Address - Fax:781-998-0228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care