Provider Demographics
NPI:1972052405
Name:STONEWELL CARE
Entity type:Organization
Organization Name:STONEWELL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-510-3843
Mailing Address - Street 1:859 WILLARD ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7482
Mailing Address - Country:US
Mailing Address - Phone:180-098-5535
Mailing Address - Fax:
Practice Address - Street 1:859 WILLARD ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7482
Practice Address - Country:US
Practice Address - Phone:180-098-5535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1294251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1Medicaid
MA1Medicaid