Provider Demographics
NPI:1245501725
Name:TOTALCARE HOME HEALTH OF MASSACHUSETTS, LLC
Entity type:Organization
Organization Name:TOTALCARE HOME HEALTH OF MASSACHUSETTS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YEWANDE
Authorized Official - Middle Name:
Authorized Official - Last Name:EFODILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-931-9068
Mailing Address - Street 1:100 LOCKE DR
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-7235
Mailing Address - Country:US
Mailing Address - Phone:617-427-7001
Mailing Address - Fax:617-427-7002
Practice Address - Street 1:100 LOCKE DR
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-7235
Practice Address - Country:US
Practice Address - Phone:617-427-7001
Practice Address - Fax:617-427-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-16
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110095890AMedicaid
22-7488Medicare PIN
MA110095890AMedicaid