1922087667 NPI number — NEVILLE COMMUNITIES HOME INC

Table of content: (NPI 1922087667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922087667 NPI number — NEVILLE COMMUNITIES HOME INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEVILLE COMMUNITIES HOME 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:
NEVILLE CENTER AT FRESH POND
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:
1922087667
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
640 CONCORD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02138-1116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-497-0600
Provider Business Mailing Address Fax Number:
617-864-0415

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
640 CONCORD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02138-1116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-497-0600
Provider Business Practice Location Address Fax Number:
617-864-0415
Provider Enumeration Date:
01/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KARR
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
617-497-0600

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0680 , 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: 0926213 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100698 . This is a "EVERCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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