Provider Demographics
NPI:1477011211
Name:M&L PRODIGY HEALTHCARE INC
Entity Type:Organization
Organization Name:M&L PRODIGY HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:NDANSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-557-8134
Mailing Address - Street 1:85 TOWER OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-2113
Mailing Address - Country:US
Mailing Address - Phone:781-557-8134
Mailing Address - Fax:978-657-7542
Practice Address - Street 1:85 TOWER OFFICE PARK
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-2113
Practice Address - Country:US
Practice Address - Phone:781-557-8134
Practice Address - Fax:978-737-9051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-11
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric