Provider Demographics
NPI:1073753737
Name:2ND HOME ADHC, LLC DBA AREVIK ADHC
Entity Type:Organization
Organization Name:2ND HOME ADHC, LLC DBA AREVIK ADHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:INNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PROSHAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-854-0678
Mailing Address - Street 1:51 WATER ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4611
Mailing Address - Country:US
Mailing Address - Phone:617-924-1212
Mailing Address - Fax:617-924-1228
Practice Address - Street 1:51 WATER ST UNIT B
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4611
Practice Address - Country:US
Practice Address - Phone:617-924-1212
Practice Address - Fax:617-924-1228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
1907069OtherPROVIDER NUMBER