Provider Demographics
NPI:1073944294
Name:AVIVA CARE
Entity Type:Organization
Organization Name:AVIVA CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WOLF
Authorized Official - Middle Name:
Authorized Official - Last Name:GAFANOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:617-513-2158
Mailing Address - Street 1:30 BONTEMPO RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3640
Mailing Address - Country:US
Mailing Address - Phone:617-513-2158
Mailing Address - Fax:
Practice Address - Street 1:30 BONTEMPO RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459
Practice Address - Country:US
Practice Address - Phone:617-513-2158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care