Provider Demographics
NPI:1285178707
Name:BOSTON & BOSTON ENTERPRISE HOME CARE
Entity Type:Organization
Organization Name:BOSTON & BOSTON ENTERPRISE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:BOSTON
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:845-323-3725
Mailing Address - Street 1:713 DUVAL STATION RD
Mailing Address - Street 2:STE 107255
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218
Mailing Address - Country:US
Mailing Address - Phone:845-323-3725
Mailing Address - Fax:
Practice Address - Street 1:713 DUVAL STATION RD
Practice Address - Street 2:STE 107255
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218
Practice Address - Country:US
Practice Address - Phone:845-323-3725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOSTON & BOSTON ENTERPRISE, LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health