1235335704 NPI number — DIGITRACE CARE SERVICES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235335704 NPI number — DIGITRACE CARE SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIGITRACE CARE SERVICES 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:
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:
1235335704
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 CORPORATE PL
Provider Second Line Business Mailing Address:
SUITE 5B
Provider Business Mailing Address City Name:
PEABODY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01960-3840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 W EXCHANGE ST
Provider Second Line Business Practice Location Address:
STE 100B
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02903-1004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-831-0607
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROSE
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF FINANCE AND ADMINISTRATION
Authorized Official Telephone Number:
978-536-6105

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 23848 . This is a "NEIGHBORHOOD HP RI - PIN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 005143 . This is a "BLUE CHIP RI - PIN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 2860005 . This is a "AETNA HMO - PIN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000023950 . This is a "BCBS OF RI - PIN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 768313 . This is a "TUFTS - PIN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 48-00349 . This is a "UNITED HEALTHCARE - PIN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 7618325 . This is a "AETNA PPO - PIN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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