Provider Demographics
NPI:1881281558
Name:SULLY HOME CARE SERVICES
Entity type:Organization
Organization Name:SULLY HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OSMAN
Authorized Official - Middle Name:ERMANN
Authorized Official - Last Name:SULLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-510-6963
Mailing Address - Street 1:490 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:MA
Mailing Address - Zip Code:02322-1663
Mailing Address - Country:US
Mailing Address - Phone:617-212-6527
Mailing Address - Fax:508-510-6963
Practice Address - Street 1:490 W MAIN ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:MA
Practice Address - Zip Code:02322-1663
Practice Address - Country:US
Practice Address - Phone:617-212-6527
Practice Address - Fax:508-510-6963
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SULLY HOME CARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker