Provider Demographics
NPI:1356744999
Name:SANTOS COMPLETE HOME CARE
Entity type:Organization
Organization Name:SANTOS COMPLETE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SELMA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:P C
Authorized Official - Phone:508-247-7084
Mailing Address - Street 1:PO BOX 251
Mailing Address - Street 2:
Mailing Address - City:EASTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02642-0251
Mailing Address - Country:US
Mailing Address - Phone:508-247-7084
Mailing Address - Fax:774-801-2056
Practice Address - Street 1:520 DOANE RD
Practice Address - Street 2:
Practice Address - City:EASTHAM
Practice Address - State:MA
Practice Address - Zip Code:02642-2271
Practice Address - Country:US
Practice Address - Phone:508-247-7084
Practice Address - Fax:774-801-2056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAATN59019Medicaid