Basic Information
| Provider Information | |||||||||
| NPI: | 1093260705 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PATRIOT ELDER CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1261 FURNACE BROOK PKWY | ||||||||
| Address2: | SUITE #21 | ||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021694721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174794545 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1261 FURNACE BROOK PKWY | ||||||||
| Address2: | SUITE #21 | ||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021694721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174794545 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2016 | ||||||||
| LastUpdateDate: | 08/23/2016 | ||||||||
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| AuthorizedOfficialLastName: | ACCARDI | ||||||||
| AuthorizedOfficialFirstName: | ALEJANDRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6174794545 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 4SVE | MA | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.