Provider Demographics
NPI:1679635270
Name:PASSIONATE CARE PROVIDERS
Entity Type:Organization
Organization Name:PASSIONATE CARE PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:C
Authorized Official - Last Name:OGBONNANZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-767-1744
Mailing Address - Street 1:3 SPRING LN
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:MA
Mailing Address - Zip Code:02343-2042
Mailing Address - Country:US
Mailing Address - Phone:781-767-1744
Mailing Address - Fax:617-427-7002
Practice Address - Street 1:3 SPRING LN
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:MA
Practice Address - Zip Code:02343-2042
Practice Address - Country:US
Practice Address - Phone:781-767-1744
Practice Address - Fax:617-427-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0611557Medicaid
MA0611557Medicaid