Provider Demographics
NPI:1114759362
Name:MASS SENIOR CARE LLC CIVILITY HOME CARE
Entity type:Organization
Organization Name:MASS SENIOR CARE LLC CIVILITY HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-947-6086
Mailing Address - Street 1:81 MARKET SQ.
Mailing Address - Street 2:ROOM 2
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111
Mailing Address - Country:US
Mailing Address - Phone:413-474-7438
Mailing Address - Fax:888-646-4877
Practice Address - Street 1:1500 MAIN STREET
Practice Address - Street 2:8TH FLOOR- UNIT 800
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01115
Practice Address - Country:US
Practice Address - Phone:413-474-7438
Practice Address - Fax:888-616-4877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care