Provider Demographics
NPI:1376597104
Name:TOWN OF ACTON
Entity Type:Organization
Organization Name:TOWN OF ACTON
Other - Org Name:ACTON PUBLIC HEALTH NURSING SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MERRILY
Authorized Official - Middle Name:
Authorized Official - Last Name:EVDOKIMOFF
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:978-264-9653
Mailing Address - Street 1:472 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3952
Mailing Address - Country:US
Mailing Address - Phone:978-264-9653
Mailing Address - Fax:978-264-4405
Practice Address - Street 1:472 MAIN ST
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3952
Practice Address - Country:US
Practice Address - Phone:978-264-9653
Practice Address - Fax:978-264-4405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
120057OtherBLUE CROSS BLUE SHIELD
300529OtherTUFTS HEALTH PLAN
MA0601918Medicaid
MA0601918Medicaid
MA227057Medicare ID - Type Unspecified