Provider Demographics
NPI:1811321417
Name:NO BUSINESS
Entity type:Organization
Organization Name:NO BUSINESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURETTE
Authorized Official - Middle Name:THEODULE
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:781-526-6522
Mailing Address - Street 1:172 ADAMS ST
Mailing Address - Street 2:APT#2
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-3910
Mailing Address - Country:US
Mailing Address - Phone:781-526-6522
Mailing Address - Fax:
Practice Address - Street 1:172 ADAMS ST
Practice Address - Street 2:APT#2
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-3910
Practice Address - Country:US
Practice Address - Phone:781-526-6522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN236191314000000X
MA313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility