1093744286 NPI number — METRO WEST REHAB CORP

Table of content: (NPI 1093744286)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093744286 NPI number — METRO WEST REHAB CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METRO WEST REHAB CORP
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:
1093744286
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 RAILROAD SQ
Provider Second Line Business Mailing Address:
SUITE 503
Provider Business Mailing Address City Name:
HAVERHILL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01832-5721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-556-5907
Provider Business Mailing Address Fax Number:
978-521-8818

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 FLANDERS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTBOROUGH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01581-1017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-871-2000
Provider Business Practice Location Address Fax Number:
508-871-2048
Provider Enumeration Date:
07/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ARCIDI
Authorized Official First Name:
ALFRED
Authorized Official Middle Name:
J
Authorized Official Title or Position:
SENIOR VICE PRESIDENT
Authorized Official Telephone Number:
978-556-5858

Provider Taxonomy Codes

  • Taxonomy code: 282E00000X , with the licence number:  104 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 283X00000X , with the licence number: 104 , 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: S011971 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 413150 . This is a "CIGNA/HEALTHSOURCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2222303310 . This is a "BLUE CROSS (OUTPATIENT)" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 873262 . This is a "AETNA/US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5080305 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0019446 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 110027433A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1103237 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 613991 . This is a "TUFTS HEALTH PLAN (OP)" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 110027433B , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1211854 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2222303301 . This is a "BLUE CROSS (IP)" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2222303302 . This is a "BLUE CROSS IP LEV 2" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 613898 . This is a "TUFTS HEALTH PLAN (IP)" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 903265 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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