Provider Demographics
NPI:1548212772
Name:MOTHER ST. JOSEPH HOUSE, INC.
Entity Type:Organization
Organization Name:MOTHER ST. JOSEPH HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CITRO, SND
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:781-246-2194
Mailing Address - Street 1:7 EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-2728
Mailing Address - Country:US
Mailing Address - Phone:781-246-2194
Mailing Address - Fax:781-224-0582
Practice Address - Street 1:7 EMERSON ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-2728
Practice Address - Country:US
Practice Address - Phone:781-246-2194
Practice Address - Fax:781-224-0582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1N6F310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility