Provider Demographics
NPI:1346615432
Name:LILAC HOMECARE LLC
Entity Type:Organization
Organization Name:LILAC HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:MUTHONI
Authorized Official - Last Name:KURIA
Authorized Official - Suffix:
Authorized Official - Credentials:RN-BSN
Authorized Official - Phone:508-736-0701
Mailing Address - Street 1:210 PARK AVE
Mailing Address - Street 2:SUITE 162
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2246
Mailing Address - Country:US
Mailing Address - Phone:508-736-0701
Mailing Address - Fax:
Practice Address - Street 1:210 PARK AVE
Practice Address - Street 2:SUITE 162
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2246
Practice Address - Country:US
Practice Address - Phone:508-736-0701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA001199369251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health