Provider Demographics
NPI:1861730715
Name:FAMILY CAREGIVERS
Entity type:Organization
Organization Name:FAMILY CAREGIVERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DE LA ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-477-8290
Mailing Address - Street 1:891 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2776
Mailing Address - Country:US
Mailing Address - Phone:617-522-0630
Mailing Address - Fax:617-477-8292
Practice Address - Street 1:891 CENTRE ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2776
Practice Address - Country:US
Practice Address - Phone:617-477-8290
Practice Address - Fax:617-477-8292
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GUARDIAN HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-28
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110085134BMedicaid
MA110085134AMedicaid
MA110085134AMedicaid