Seraphic Springs Health Care Agency, Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

227446 Issued in MA

Legal business name

SERAPHIC SPRINGS HEALTH CARE AGENCY, INC.

Practice address

425 Western Ave
Lynn, MA 01904-3317

Phone

(781) 780-6515

Fax

(781) 593-3618

NPI assigned

May 27, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Foluso Omotola Olubanjo

Title

Administrator/Owner

Phone

(781) 780-6515

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063415602. Details of each certification follow.

• CCN 227446 Home health agency · Active · Details

Home health agency certification: CCN 227446

Legal name

SERAPHIC SPRINGS HEALTH CARE AGENCY, INC.

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Sep 3, 1996

Last certification

Feb 8, 2018

Ownership / control type

Proprietary

Organization structure

CorporationProprietary

Incorporated

Aug 23, 1996 in MA

Enrollment address

425 Western Ave
Lynn, MA 01904-3317

Listed as

Seraphic Springs HealthcareCCN 227446 · All quality measures

Ownership

Proprietary

Certified

Sep 3, 1996

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Home health aide, Physical therapy, Occupational therapy

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445299200000",
    "number": "1063415602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 WESTERN AVE",
            "city": "LYNN",
            "state": "MA",
            "postal_code": "019043317",
            "telephone_number": "781-780-6515",
            "fax_number": "781-593-3618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 WESTERN AVE",
            "city": "LYNN",
            "state": "MA",
            "postal_code": "019043317",
            "telephone_number": "781-780-6515",
            "fax_number": "781-593-3618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERAPHIC SPRINGS HEALTH CARE AGENCY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-27",
        "last_updated": "2015-10-20",
        "status": "A",
        "authorized_official_last_name": "OLUBANJO",
        "authorized_official_first_name": "FOLUSO",
        "authorized_official_middle_name": "OMOTOLA",
        "authorized_official_title_or_position": "ADMINISTRATOR/OWNER",
        "authorized_official_telephone_number": "781-780-6515",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MA",
            "license": "227446",
            "primary": true
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "ME",
            "license": "227446",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0607002",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MASSHEALTH",
            "identifier": "110024476A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in Lynn, MA
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• Home Health Agency in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.