Provider Demographics
NPI:1609998467
Name:OLD COLONY ELDERLY SERVICES, INC.
Entity Type:Organization
Organization Name:OLD COLONY ELDERLY SERVICES, INC.
Other - Org Name:PERSONAL CARE MANAGEMENT AGENCY
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIGIORGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-584-1561
Mailing Address - Street 1:144 MAIN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4046
Mailing Address - Country:US
Mailing Address - Phone:508-584-1561
Mailing Address - Fax:
Practice Address - Street 1:144 MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4046
Practice Address - Country:US
Practice Address - Phone:508-584-1561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1948539Medicaid