Provider Demographics
NPI:1679875918
Name:CITY HOME CARE, LLC
Entity type:Organization
Organization Name:CITY HOME CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-964-2489
Mailing Address - Street 1:425 LAKE AVE N STE 102
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2073
Mailing Address - Country:US
Mailing Address - Phone:617-964-2489
Mailing Address - Fax:
Practice Address - Street 1:425 LAKE AVE N STE 102
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2073
Practice Address - Country:US
Practice Address - Phone:617-964-2489
Practice Address - Fax:617-964-2490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110092840GMedicaid