Provider Demographics
NPI:1477970218
Name:PRIORITY PROFESSIONAL CARE,LLC
Entity Type:Organization
Organization Name:PRIORITY PROFESSIONAL CARE,LLC
Other - Org Name:ADULT FOSTER CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:STAFF NURSE
Authorized Official - Prefix:
Authorized Official - First Name:GEORGES
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCHEINE
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:781-771-1514
Mailing Address - Street 1:36 PLAIN ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-4922
Mailing Address - Country:US
Mailing Address - Phone:781-771-1514
Mailing Address - Fax:
Practice Address - Street 1:1613 BLUE HILL AVE STE 302
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-2114
Practice Address - Country:US
Practice Address - Phone:857-598-4774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency