| Organization Name: | BAYSTATE MARY LANE HOSPITAL CORPORATION |
| NPI Number: | 1144221847 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DENNIS W CHALKE (VP FINANCE, HEALTHCARE OPERATIONS) |
| Mailing Address: | 85 South St Ware |
| State: | MA US |
| Postal Code: | 010821625 |
| Phone Number: | 4139676211 |
| Fax Number: | |
| NPI Enumeration Date: | 08/03/2005 |
| NPI Last Update Date: | 03/11/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA0600X |
| License Number: | 2148 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Adult Day Care |
| Taxonomy Definition: | |