Provider Demographics
NPI:1659004059
Name:GERIATRIC HOME CARE AGENCY LLC
Entity Type:Organization
Organization Name:GERIATRIC HOME CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VALMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-903-0420
Mailing Address - Street 1:23 TRESCOTT ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3265
Mailing Address - Country:US
Mailing Address - Phone:617-637-7697
Mailing Address - Fax:
Practice Address - Street 1:23 TRESCOTT ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3265
Practice Address - Country:US
Practice Address - Phone:617-637-7697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care