Organization
MEDFORD ADHC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GENNADIY ITSKIN (OWNER)
(617) 839-8299
Entity
Organization
Contact information
Practice address
101 MYSTIC AVE, MEDFORD, MA 02155-4628
(617) 839-8299
Mailing address
101 MYSTIC AVE, MEDFORD, MA 02155-4628
(617) 839-8299
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
—
MA
Other
Enumeration date
01/20/2016
Last updated
01/20/2016
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