# SUPPLEMANTAL HEALTH CARE SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356593743
- **Authorized official:** MR. LUIS E PACHECO PTA (PHYSICAL THERAPIST ASSISTANT)
- **Authorized official phone:** (617) 407-0592

## Contact information

- **Practice address:** 731 TRUMAN HWY, HYDE PARK, MA 02136
- **Practice address phone:** (617) 407-0592
- **Mailing address:** 731 TRUMAN HWY, HYDE PARK, MA 02136-3517

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320700000X | Physical Disabilities Residential Treatment Facility | 7620 | MA | Yes |

## Other

- **Enumeration date:** 10/16/2008
- **Last updated:** 10/16/2008