1083748867 NPI number — NEW ENGLAND LIFE CARE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083748867 NPI number — NEW ENGLAND LIFE CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW ENGLAND LIFE CARE, 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:
Provider Other Organization Name Type Code:
6
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:
1083748867
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 CENTER ST STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCARBOROUGH
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04074-6503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-321-6352
Provider Business Mailing Address Fax Number:
207-321-6353

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41C TERRILL PARK DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-338-8022
Provider Business Practice Location Address Fax Number:
603-225-0684
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GALLAGHER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
781-932-4347

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2603743Y0NH01 . This is a "ANTHEM NH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 3005217 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1005411 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 80002441 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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