1437161163 NPI number — DIGITRACE CARE SERVICES, INC

Table of content: (NPI 1437161163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437161163 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:
1437161163
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2016
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:
978-536-7400
Provider Business Mailing Address Fax Number:
978-535-9757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4710 W 95TH ST
Provider Second Line Business Practice Location Address:
SUITE A6
Provider Business Practice Location Address City Name:
OAK LAWN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60453-2546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-423-4693
Provider Business Practice Location Address Fax Number:
708-423-5279
Provider Enumeration Date:
08/12/2006

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 & ADMINISTRATION
Authorized Official Telephone Number:
978-536-7400

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7618325 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00452102 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 8011510 . This is a "CIGNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 01619296 . This is a "FEDERAL BCIL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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