Provider Demographics
NPI:1083980106
Name:SUPPORTIVE CARE
Entity Type:Organization
Organization Name:SUPPORTIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-324-6333
Mailing Address - Street 1:6 PLEASANT ST
Mailing Address - Street 2:SUITE 414
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-5100
Mailing Address - Country:US
Mailing Address - Phone:781-324-6333
Mailing Address - Fax:781-324-7354
Practice Address - Street 1:6 PLEASANT ST
Practice Address - Street 2:SUITE 414
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5100
Practice Address - Country:US
Practice Address - Phone:781-324-6333
Practice Address - Fax:781-324-7354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care