Organization
NO BUSINESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAURETTE THEODULE JOSEPH RN (RN)
(781) 526-6522
Entity
Organization
Contact information
Practice address
172 ADAMS ST, APT#2, WALTHAM, MA 02453-3910
(781) 526-6522
Mailing address
172 ADAMS ST, APT#2, WALTHAM, MA 02453-3910
(781) 526-6522
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
—
MA
314000000X
Skilled Nursing Facility
RN236191
MA
Other
Enumeration date
08/30/2013
Last updated
08/30/2013
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