1669468799 NPI number — SACHEM ASSOCIATES, INC.

Table of content: (NPI 1669468799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669468799 NPI number — SACHEM ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SACHEM ASSOCIATES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ANN CARROLL NURSING HOME
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669468799
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
66 JOHNSON ST
Provider Second Line Business Mailing Address:
66 JOHNSON ST
Provider Business Mailing Address City Name:
LYNN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01902-4141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-592-5849
Provider Business Mailing Address Fax Number:
781-592-7569

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
66 JOHNSON ST
Provider Second Line Business Practice Location Address:
66 JOHNSON ST
Provider Business Practice Location Address City Name:
LYNN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01902-4141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-592-5849
Provider Business Practice Location Address Fax Number:
781-592-7569
Provider Enumeration Date:
09/23/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VALERI
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/ADMINISTRATOR
Authorized Official Telephone Number:
781-592-5849

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0331 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0915572 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".