1760426282 NPI number — NORTHWOOD MA SNF LLC

Table of content: (NPI 1760426282)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760426282 NPI number — NORTHWOOD MA SNF LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWOOD MA SNF LLC
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:
1760426282
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1010 VARNUM AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOWELL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01854-1915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-879-4050
Provider Business Mailing Address Fax Number:
508-879-1534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 VARNUM AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOWELL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-458-8773
Provider Business Practice Location Address Fax Number:
978-458-6366
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SANTILLI
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
860-751-3900

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0838 , 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: 110094540A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2222529801 . This is a "BC/BS OF MA PROVIDER NUMB" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 907339 . This is a "HARVARD PILGRIM PROV NUMB" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 914985 . This is a "TUFTS MEDICARE PREFERRED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 249 . This is a "FALLON VENDOR CODE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7100155 . This is a "EVERCARE PROV #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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