Provider Demographics
NPI:1497143762
Name:PRIORITY HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:PRIORITY HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:TEKUM
Authorized Official - Middle Name:FOMUM
Authorized Official - Last Name:PENTOCOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:HOME CARE SERVICES
Authorized Official - Phone:617-230-6824
Mailing Address - Street 1:43 CUMMINS HIGH WAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02131
Mailing Address - Country:US
Mailing Address - Phone:617-230-6824
Mailing Address - Fax:
Practice Address - Street 1:43 CUMMINS HIGH WAY
Practice Address - Street 2:SUITE 3
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02131
Practice Address - Country:US
Practice Address - Phone:617-230-6824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8181251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health