1720099179 NPI number — DIGITRACE CARE SERVICES INC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720099179 NPI number — DIGITRACE CARE SERVICES INC

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 Other Organization Name:

SLEEPMED

Provider Other Organization Name Type Code:

3

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:

1720099179

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

02/07/2017

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

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 First Line Business Practice Location Address:

10 DORRANCE ST

Provider Second Line Business Practice Location Address:

SUITE 735 7TH FLOOR

Provider Business Practice Location Address City Name:

PROVIDENCE

Provider Business Practice Location Address State Name:

RI

Provider Business Practice Location Address Postal Code:

02903-2018

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

401-519-3787

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

08/11/2006

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

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

• Identifier: 6178 . This is a "FALLON" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 3400027 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 409503 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 607536 . This is a "TUFTS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: SF038169 . This is a "BCBS OF MA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 0000022164 . This is a "BC/BS OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 9513801 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 626067 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 0274 . This is a "NEIGHBORHOOD HP RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 2860005 . This is a "AETNA HMO" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 7618325 . This is a "AETNA PPO" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
• Identifier: 9468 . This is a "NEIGHBORHOOD HP MA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".