1841290467 NPI number — MELROSEWAKEFIELD HEALTHCARE, INC.

Table of content: (NPI 1841290467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841290467 NPI number — MELROSEWAKEFIELD HEALTHCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MELROSEWAKEFIELD HEALTHCARE, 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:
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:
1841290467
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
170 GOVERNORS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDFORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02155-1643
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
170 GOVERNORS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02155-1643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-979-3050
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GREEN
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
EVP CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
787-887-1439

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  VKB3 , 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: 1000403 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 900147 . This is a "HP LAWRENCE ALL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 900262 . This is a "HP MELROSE ALL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0018036 . This is a "NHP ALL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0018183 . This is a "NHP FHC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1004805 . This is a "NHP PSYCH OP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2222007030 . This is a "BC SDC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2222007001 . This is a "BC INPATIENT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 900012 . This is a "TUFTS LAWRENCE INPATIENT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 905174 . This is a "TUFTS MELROSE OUTPATIENT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 996129 . This is a "NETWORK ALL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1903241 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 905178 . This is a "TUFTS MALDEN AND FHC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2222007010 . This is a "BC OUTPATIENT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 905173 . This is a "TUFTS MELROSE INPATIENT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1211382 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1200992 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 900005 . This is a "TUFTS LAWRENCE OUTPATIENT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 900348 . This is a "HP MALDEN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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