Provider Demographics
NPI:1659067668
Name:IMMACULATE HOME HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:IMMACULATE HOME HEALTH CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:MILDRED
Authorized Official - Last Name:WOGHIREN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP, MSN
Authorized Official - Phone:857-488-6610
Mailing Address - Street 1:21 HARDING RD
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-3808
Mailing Address - Country:US
Mailing Address - Phone:857-488-6610
Mailing Address - Fax:
Practice Address - Street 1:21 HARDING RD
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-3808
Practice Address - Country:US
Practice Address - Phone:857-488-6610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IMMACULATE HEALTH CARE SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty