1275561383 NPI number — NEW ENGLAND LONG TERM CARE, INC.

Table of content: (NPI 1275561383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275561383 NPI number — NEW ENGLAND LONG TERM CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW ENGLAND LONG TERM CARE, 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:
1275561383
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
78 BOSTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
N BILLERICA
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01862-1034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-667-5123
Provider Business Mailing Address Fax Number:
978-663-5154

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
78 BOSTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BILLERICA
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01862-1034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-667-5123
Provider Business Practice Location Address Fax Number:
978-663-5154
Provider Enumeration Date:
06/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
O'GORMAN
Authorized Official First Name:
ELLEN
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
978-667-5123

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0756 , 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: 0930377 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 551849 . This is a "AETNA-HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2222599910 . This is a "BC/BS - OUTPATIENT REHAB" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 710039 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2222599901 . This is a "BC/BS - MEDICARE BLUE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2222599902 . This is a "BC/BS-IND/PPO/VENT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0020348 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 904729 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".




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