Provider Demographics
NPI:1194220368
Name:PROMISED CARE LLC
Entity Type:Organization
Organization Name:PROMISED CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:ETTA
Authorized Official - Last Name:AGBOR-BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-227-8807
Mailing Address - Street 1:80 SOMERSET AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-2943
Mailing Address - Country:US
Mailing Address - Phone:978-227-8807
Mailing Address - Fax:978-400-7492
Practice Address - Street 1:80 SOMERSET AVE STE 2
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-2943
Practice Address - Country:US
Practice Address - Phone:978-227-8807
Practice Address - Fax:978-400-7492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA99999OtherJAMMING