| NPI | 1225162415 |
|---|---|
| Doing Business As | PROVIDENCE HOUSE SENIOR LIVING COMMUNITY |
| Entity Type | Organization |
| Authorized Contact | RICHARD JOHNSON Executive Director 617-731-0505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2020-08-22 |