1811988645 NPI number — SISTERS OF PROVIDENCE CARE CENTERS INC.

Table of content: (NPI 1811988645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811988645 NPI number — SISTERS OF PROVIDENCE CARE CENTERS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SISTERS OF PROVIDENCE CARE CENTERS 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:
PROVIDENCE CARE CENTER OF LENOX
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:
1811988645
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 PITTSFIELD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LENOX
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01240-2377
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-637-2660
Provider Business Mailing Address Fax Number:
413-637-3085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 PITTSFIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LENOX
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01240-2377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-637-2660
Provider Business Practice Location Address Fax Number:
413-637-3085
Provider Enumeration Date:
11/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MCLAUGHLIN
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
413-539-2917

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0021 , 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: 0021 . This is a "STATE NURSING HOME LICENS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0924229 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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