Provider Demographics
NPI:1144986191
Name:HOMEVAXX LLC
Entity type:Organization
Organization Name:HOMEVAXX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WAWERU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-335-4690
Mailing Address - Street 1:54 RIVERNECK RD
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2925
Mailing Address - Country:US
Mailing Address - Phone:978-344-0833
Mailing Address - Fax:
Practice Address - Street 1:54 RIVERNECK RD
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2925
Practice Address - Country:US
Practice Address - Phone:508-335-4690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-15
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care