1295214104 NPI number — SAVCARE HEALTH CO

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 1295214104 NPI number — SAVCARE HEALTH CO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAVCARE HEALTH CO
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:
1295214104
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 PAYSON RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
FOXBOROUGH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02035-1394
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
774-765-1616
Provider Business Mailing Address Fax Number:
774-765-1617

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 PAYSON RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
FOXBOROUGH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02035-1394
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
774-765-1616
Provider Business Practice Location Address Fax Number:
774-765-1617
Provider Enumeration Date:
08/10/2018

Additional Information

Authorized Official

Authorized Official Last Name:
SHARMA
Authorized Official First Name:
AJAY
Authorized Official Middle Name:
Authorized Official Title or Position:
GM
Authorized Official Telephone Number:
774-765-1616

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , 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: 110145643A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: PHN11568 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




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