Provider Demographics
NPI:1003594417
Name:MAMA DORIS FOUNDATION INC
Entity Type:Organization
Organization Name:MAMA DORIS FOUNDATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JENTZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-261-8482
Mailing Address - Street 1:360 W BOYLSTON ST RM 215
Mailing Address - Street 2:
Mailing Address - City:WEST BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01583-2368
Mailing Address - Country:US
Mailing Address - Phone:774-261-8482
Mailing Address - Fax:774-261-8480
Practice Address - Street 1:360 W BOYLSTON ST RM 215
Practice Address - Street 2:
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-2368
Practice Address - Country:US
Practice Address - Phone:774-261-8482
Practice Address - Fax:774-261-8480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-06
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care