1922097633 NPI number — WESTERN MASSACHUSETTS LIFECARE CORPORATION, INC

Table of content: (NPI 1922097633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922097633 NPI number — WESTERN MASSACHUSETTS LIFECARE CORPORATION, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN MASSACHUSETTS LIFECARE CORPORATION, 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:
REEDS LANDING
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:
1922097633
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
807 WILBRAHAM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01109-2067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-782-1800
Provider Business Mailing Address Fax Number:
413-782-8038

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
807 WILBRAHAM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01109-2067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-782-1800
Provider Business Practice Location Address Fax Number:
413-782-8038
Provider Enumeration Date:
10/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WINTERS
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
DIRECTOR OF FINANCE
Authorized Official Telephone Number:
413-782-1800

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0990 , 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: 0922315 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com