Provider Demographics
NPI:1376089169
Name:THERESA KIRBY
Entity Type:Organization
Organization Name:THERESA KIRBY
Other - Org Name:THERESA KIRBY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MISS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:AGATHA
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:617-905-3216
Mailing Address - Street 1:119 ROBBINS ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-2535
Mailing Address - Country:US
Mailing Address - Phone:617-905-3216
Mailing Address - Fax:
Practice Address - Street 1:119 ROBBINS ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-2535
Practice Address - Country:US
Practice Address - Phone:617-905-3216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205111311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home