1043359854 NPI number — CARITAS ST ELIZABETH HEALTH CARE

Table of content: (NPI 1043359854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043359854 NPI number — CARITAS ST ELIZABETH HEALTH CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARITAS ST ELIZABETH HEALTH CARE
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:
6
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:
1043359854
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
77 WARREN ST
Provider Second Line Business Mailing Address:
PHCY DEPT
Provider Business Mailing Address City Name:
BRIGHTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02135-3601
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:
77 WARREN ST
Provider Second Line Business Practice Location Address:
PHCY DEPT
Provider Business Practice Location Address City Name:
BRIGHTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02135-3601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-562-5304
Provider Business Practice Location Address Fax Number:
617-562-5296
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GERMANO
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
PHCY MGR
Authorized Official Telephone Number:
617-562-5302

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336M0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336M0003X , with the licence number: MA0148848 , 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: 2226175 . This is a "OTHER ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0401200 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2226175 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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