Provider Demographics
NPI:1548681182
Name:AWAKENING EXCELLENCE LLC
Entity type:Organization
Organization Name:AWAKENING EXCELLENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RENELIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-930-4637
Mailing Address - Street 1:6 MCENELLY CIR
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-3672
Mailing Address - Country:US
Mailing Address - Phone:617-930-4637
Mailing Address - Fax:
Practice Address - Street 1:1208A VFW PKWY
Practice Address - Street 2:SUITE 7
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-4338
Practice Address - Country:US
Practice Address - Phone:617-930-4637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-28
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care