Provider Demographics
NPI:1124662283
Name:FAULKNER HOMECARE LLC
Entity type:Organization
Organization Name:FAULKNER HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAMASUS
Authorized Official - Middle Name:
Authorized Official - Last Name:NWACHUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-262-3743
Mailing Address - Street 1:141 MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-4511
Mailing Address - Country:US
Mailing Address - Phone:781-262-3743
Mailing Address - Fax:617-262-3744
Practice Address - Street 1:141 MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-4511
Practice Address - Country:US
Practice Address - Phone:781-262-3743
Practice Address - Fax:617-262-3744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health