1821114976 NPI number — HUNTLEIGH HEALTHCARE LLC

Table of content: (NPI 1821114976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821114976 NPI number — HUNTLEIGH HEALTHCARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUNTLEIGH HEALTHCARE LLC
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:
Provider Other Organization Name Type Code:
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:
1821114976
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 CHRISTOPHER WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EATONTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07724-3327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-223-1218
Provider Business Mailing Address Fax Number:
732-676-1096

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 MILLBURY ST
Provider Second Line Business Practice Location Address:
BLDG. 9 UNITS A, B, C
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01607-1475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-767-3404
Provider Business Practice Location Address Fax Number:
508-767-3405
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ANGEL
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
PRES/CEO
Authorized Official Telephone Number:
800-223-1218

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 124890 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 005577 . This is a "SWH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 82-01021 . This is a "EVERCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1540386 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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