Organization
MYSTIC VALLEY ELDER SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SEAN HUBACZ (DIRECTOR OF FINANCE)
(781) 324-7705
Entity
Organization
Contact information
Practice address
300 COMMERCIAL ST STE 19, MALDEN, MA 02148-7311
(781) 324-7705
(781) 324-1369
Mailing address
300 COMMERCIAL ST STE 19, MALDEN, MA 02148-7311
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1902342
GAFC PROVIDER NUMBER
MA
Enumeration date
02/28/2007
Last updated
08/22/2020
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