1831145119 NPI number — KER-WESTERLUND FUNERAL HOME INC.

Table of content: (NPI 1831145119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831145119 NPI number — KER-WESTERLUND FUNERAL HOME INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KER-WESTERLUND FUNERAL HOME 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:
1831145119
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 MAIN ST
Provider Second Line Business Mailing Address:
SUITE 2K
Provider Business Mailing Address City Name:
SUTTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01590-1660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-476-9740
Provider Business Mailing Address Fax Number:
508-476-9748

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
57 HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRATTLEBORO
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05301-6749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-258-6500
Provider Business Practice Location Address Fax Number:
802-254-7300
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HILTON
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
802-258-6500

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 71Y002265VT01 . This is a "BCBS NH PROV NUMBER" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 7700903 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 99006478 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7700903 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: VT6478 . This is a "BCBS VT PROV NUMBER" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1002265 . This is a "BCBS ME PROV NUMBER" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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