Provider Demographics
NPI:1891466579
Name:BUGANDA RESIDENTIAL ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:BUGANDA RESIDENTIAL ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FIONA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAWEESA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-310-5442
Mailing Address - Street 1:479 STATE RD UNIT 475
Mailing Address - Street 2:
Mailing Address - City:WEST TISBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02575-2520
Mailing Address - Country:US
Mailing Address - Phone:774-310-5442
Mailing Address - Fax:
Practice Address - Street 1:24 CRESCENT ST STE 105
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-4310
Practice Address - Country:US
Practice Address - Phone:774-310-5442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-23
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health