Provider Demographics
NPI:1831224443
Name:ELDER DAY SERVICES OF SWC INC
Entity type:Organization
Organization Name:ELDER DAY SERVICES OF SWC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:RACICOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-949-3598
Mailing Address - Street 1:196 WEST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DUDLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01571-1497
Mailing Address - Country:US
Mailing Address - Phone:508-949-3598
Mailing Address - Fax:508-949-3598
Practice Address - Street 1:196 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:DUDLEY
Practice Address - State:MA
Practice Address - Zip Code:01571-1497
Practice Address - Country:US
Practice Address - Phone:508-949-3598
Practice Address - Fax:508-949-3598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty