1114759362 NPI number — MASS SENIOR CARE LLC CIVILITY HOME CARE

Table of content: (NPI 1114759362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114759362 NPI number — MASS SENIOR CARE LLC CIVILITY HOME CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MASS SENIOR CARE LLC CIVILITY HOME 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:
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:
1114759362
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
81 MARKET SQ.
Provider Second Line Business Mailing Address:
ROOM 2
Provider Business Mailing Address City Name:
NEWINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-474-7438
Provider Business Mailing Address Fax Number:
888-646-4877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 MAIN STREET
Provider Second Line Business Practice Location Address:
8TH FLOOR- UNIT 800
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-474-7438
Provider Business Practice Location Address Fax Number:
888-616-4877
Provider Enumeration Date:
08/16/2024

Additional Information

Authorized Official

Authorized Official Last Name:
CLARK
Authorized Official First Name:
DARYN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
203-947-6086

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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