Provider Demographics
NPI:1144041674
Name:MAYOLA HOME CARE SERVICE OF NORTH SHORE, LLC
Entity type:Organization
Organization Name:MAYOLA HOME CARE SERVICE OF NORTH SHORE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:YOUM
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-299-3667
Mailing Address - Street 1:68 HARRISON AVE STE 605
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1929
Mailing Address - Country:US
Mailing Address - Phone:978-347-2466
Mailing Address - Fax:
Practice Address - Street 1:20 LYNNFIELD ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-2222
Practice Address - Country:US
Practice Address - Phone:781-299-3667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty