Provider Demographics
NPI:1932512126
Name:PRIORITY 1 ADULT FOSTER CARE, LLC
Entity Type:Organization
Organization Name:PRIORITY 1 ADULT FOSTER CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AFC NURSE
Authorized Official - Prefix:
Authorized Official - First Name:ELISANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:508-510-0018
Mailing Address - Street 1:153 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-3918
Mailing Address - Country:US
Mailing Address - Phone:508-510-0018
Mailing Address - Fax:
Practice Address - Street 1:153 SUMMER ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3918
Practice Address - Country:US
Practice Address - Phone:508-510-0018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency