1053379388 NPI number — CARE ALTERNATIVES OF MASSACHUSETTS, LLC

Table of content: (NPI 1053379388)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053379388 NPI number — CARE ALTERNATIVES OF MASSACHUSETTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARE ALTERNATIVES OF MASSACHUSETTS, LLC
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:
1053379388
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65 JACKSON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRANFORD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07016-3516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-931-9068
Provider Business Mailing Address Fax Number:
908-931-9698

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
352 BELMONT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01604-1008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-229-8390
Provider Business Practice Location Address Fax Number:
508-229-8435
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EFODILI
Authorized Official First Name:
YEWANDE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING DIRECTOR
Authorized Official Telephone Number:
908-931-9068

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  7LTY , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7LTY . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0601250 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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