Provider Demographics
NPI:1609257948
Name:CHEACARE
Entity Type:Organization
Organization Name:CHEACARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ITACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-271-3745
Mailing Address - Street 1:23 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1630
Mailing Address - Country:US
Mailing Address - Phone:617-271-3745
Mailing Address - Fax:
Practice Address - Street 1:23 LOCUST ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1630
Practice Address - Country:US
Practice Address - Phone:617-271-3745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-12
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2269332251J00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care