1700818200 NPI number — SISTERS OF PROVIDENCE INC , INFIRMARY

Table of content: (NPI 1700818200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700818200 NPI number — SISTERS OF PROVIDENCE INC , INFIRMARY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SISTERS OF PROVIDENCE INC , INFIRMARY
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:
1700818200
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:
1233 MAIN ST
Provider Second Line Business Mailing Address:
3RD FLOOR
Provider Business Mailing Address City Name:
HOLYOKE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01040-5381
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
141-349-3275
Provider Business Mailing Address Fax Number:
141-349-3275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1233 MAIN ST
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
HOLYOKE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01040-5381
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
141-349-3275
Provider Business Practice Location Address Fax Number:
141-349-3275
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CAHILLANE
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
MARY
Authorized Official Title or Position:
NURSING HOME ADMINISTRATOR
Authorized Official Telephone Number:
14134932752

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  31400000X , 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: 0923966 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 314M00000X . This is a "SKILLED NURSING FACILITY" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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