Provider Demographics
NPI:1588063812
Name:CHARISMARK INC
Entity type:Organization
Organization Name:CHARISMARK INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARION
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTYABA-PRINGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-518-3249
Mailing Address - Street 1:24 CRESCENT ST STE 102
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-4360
Mailing Address - Country:US
Mailing Address - Phone:781-518-3249
Mailing Address - Fax:781-547-5457
Practice Address - Street 1:24 CRESCENT ST STE 102
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-4360
Practice Address - Country:US
Practice Address - Phone:781-518-3249
Practice Address - Fax:781-547-5457
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARISMARK INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8420251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health