Provider Demographics
NPI:1598078172
Name:COMMUNITY ADULT DAYCARE CENTER, LLC
Entity Type:Organization
Organization Name:COMMUNITY ADULT DAYCARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SERGEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLOGOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-285-2227
Mailing Address - Street 1:120 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1014
Mailing Address - Country:US
Mailing Address - Phone:508-294-8756
Mailing Address - Fax:617-507-7931
Practice Address - Street 1:120 BROADWAY
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1014
Practice Address - Country:US
Practice Address - Phone:508-294-8756
Practice Address - Fax:617-507-7931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care