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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