1053353060 NPI number — GENESIS HEALTH VENTURES OF MASSACHUSETTS, INC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053353060 NPI number — GENESIS HEALTH VENTURES OF MASSACHUSETTS, INC

Employer Identification Number (EIN):

Provider Organization Name:

GENESIS HEALTH VENTURES OF MASSACHUSETTS, 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 Other Organization Name:

HERITAGE HALL WEST

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:

1053353060

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

06/21/2018

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

101 E STATE ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

KENNETT SQUARE

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

19348-3109

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

610-925-4436

Provider Business Mailing Address Fax Number:

610-925-4351

Provider First Line Business Practice Location Address:

61 COOPER ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

AGAWAM

Provider Business Practice Location Address State Name:

MA

Provider Business Practice Location Address Postal Code:

01001-2149

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

413-786-8000

Provider Business Practice Location Address Fax Number:

413-786-5066

Provider Enumeration Date:

06/12/2006

Authorized Official Last Name:

DROPESKEY

Authorized Official First Name:

JANE

Authorized Official Middle Name:

Authorized Official Title or Position:

CORPORATE MANAGER

Authorized Official Telephone Number:

610-925-4231

• Taxonomy code: 314000000X , with the licence number:  0809 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0940232 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: 2222525310 . This is a "BC/BS - OUTPATIENT REHAB" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 000000021321 . This is a "BOSTON MEDICAL CENTER" identifier . This identifiers is of the category "OTHER".
• Identifier: 2222525302 . This is a "BC/BS - VENT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 82566 . This is a "AETNA-HMO" identifier . This identifiers is of the category "OTHER".
• Identifier: 0020937 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 36009 . This is a "HEALTH NEW ENGLAND" identifier . This identifiers is of the category "OTHER".
• Identifier: 71-01268 . This is a "UNITED - EVERCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 905656 . This is a "HARVARD PILGRAM" identifier . This identifiers is of the category "OTHER".
• Identifier: 1580361 . This is a "CIGNA(HEALTHSOURCE OF MA)" identifier . This identifiers is of the category "OTHER".
• Identifier: 2222525301 . This is a "BC/BS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".