1174513071 NPI number — NASHOBA VALLEY HEALTHCARE GROUP INC

Table of content: (NPI 1174513071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174513071 NPI number — NASHOBA VALLEY HEALTHCARE GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NASHOBA VALLEY HEALTHCARE GROUP 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:
1174513071
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 GROTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AYER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01432-1168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-784-9325
Provider Business Mailing Address Fax Number:
978-784-9599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 GROTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AYER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01432-1168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-784-9325
Provider Business Practice Location Address Fax Number:
978-784-9599
Provider Enumeration Date:
10/24/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SWANEY
Authorized Official First Name:
LOUANN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
978-784-9325

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 9725351 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".