1740519057 NPI number — MAS MEDICAL STAFFING CORPORATION

Table of content: (NPI 1740519057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740519057 NPI number — MAS MEDICAL STAFFING CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAS MEDICAL STAFFING CORPORATION
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:
MAS HOME CARE OF MAINE
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:
1740519057
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
156 HARVEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONDONDERRY
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03053-7449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-232-0972
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 SUMMER ST
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
BANGOR
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04401-6467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-561-9533
Provider Business Practice Location Address Fax Number:
207-561-9538
Provider Enumeration Date:
12/15/2009

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
KEN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
603-232-0972

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  37952 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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