Provider Demographics
NPI:1184744120
Name:CHARIOT ADULT DAY HEALTH, INC.
Entity type:Organization
Organization Name:CHARIOT ADULT DAY HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:WILGREN
Authorized Official - Suffix:
Authorized Official - Credentials:BS GERONTOLOGY
Authorized Official - Phone:781-646-1196
Mailing Address - Street 1:31 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-3205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 WESTMINSTER AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-2733
Practice Address - Country:US
Practice Address - Phone:781-646-1196
Practice Address - Fax:781-646-1196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-31
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1903535261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1903535Medicaid