1932271632 NPI number — ELIOT COMMUNITY HUMAN SERVICES

Table of content: (NPI 1932271632)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932271632 NPI number — ELIOT COMMUNITY HUMAN SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELIOT COMMUNITY HUMAN SERVICES
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:
TRI-CITY MENTAL HEALTH AND RETARDATION CENTER
Provider Other Organization Name Type Code:
4
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:
1932271632
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 HARTWELL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02421-3100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-861-0890
Provider Business Mailing Address Fax Number:
781-861-0899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 HARTWELL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-861-0890
Provider Business Practice Location Address Fax Number:
781-861-0899
Provider Enumeration Date:
11/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARKARIAN
Authorized Official First Name:
KATE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
781-861-0890

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  4321 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0801X , with the licence number: 0730 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0009253 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1304852 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 260000472 . This is a "TRAVERLERS INS. RR-MEDICA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 702286 . This is a "TUFTS ASSOC. HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: EI0M35 . This is a "BAYSTATE HEALTH EI" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1003010 . This is a "MH NHP BEACON HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1307908 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84645 . This is a "US HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: EI0032 . This is a "EI BCBSMA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1300873 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1310275 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1800809 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: FS2030290 . This is a "ADMINISTAR DEFENSE SERVIC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 286694 . This is a "MERIT BEHAVIORAL CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: TRI2223002641 . This is a "BCBSMA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 601959 . This is a "HARVARD PILGRIM HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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