Provider Demographics
NPI:1972143121
Name:GREATWAYCARE LLC
Entity Type:Organization
Organization Name:GREATWAYCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARYANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHOME
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:978-319-7072
Mailing Address - Street 1:49 BLANCHARD ST STE 207-4
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1454
Mailing Address - Country:US
Mailing Address - Phone:978-319-7072
Mailing Address - Fax:
Practice Address - Street 1:49 BLANCHARD ST STE 207-4
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1454
Practice Address - Country:US
Practice Address - Phone:978-319-7072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health