1134178312 NPI number — SHIELDS HEALTHCARE OF CAMBRIDGE, INC.

Table of content: (NPI 1134178312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134178312 NPI number — SHIELDS HEALTHCARE OF CAMBRIDGE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHIELDS HEALTHCARE OF CAMBRIDGE, 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'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:
1134178312
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 CHRISTY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROCKTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02301-1813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-897-1501
Provider Business Mailing Address Fax Number:
508-897-1599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
385 WESTERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIGHTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02135-1005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-621-2955
Provider Business Practice Location Address Fax Number:
508-897-3599
Provider Enumeration Date:
05/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BYRD
Authorized Official First Name:
ARTHUR
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
617-376-7400

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X , with the licence number:  4420 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM1300X , with the licence number: 4420 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 110029017A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com