Organization
MI CASA ADHC, LLC
Active
Organization
MI CASA ADHC, LLC
Active
Other names
Mi Casa ADHC
Organization subpart
No
Provider details
NPI number
Authorized official
GENNADIY ITSKIN (OWNER)
(617) 839-8399
Entity
Organization
Contact information
Practice address
333 BROADWAY, LAWRENCE, MA 01841-3527
(978) 975-2696
(800) 604-6349
Mailing address
333 BROADWAY, LAWRENCE, MA 01841-3527
(978) 975-2696
(800) 604-6349
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
EIN
—
MA
Enumeration date
01/16/2018
Last updated
07/21/2022
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