Organization Name: | BAYSTATE WING HOSPITAL CORPORATION |
NPI Number: | 1518009620 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KEARY T ALLICON (TREASURER & CFO) |
Mailing Address: | 4 Springfield St., Bldg. 3, 4th Fl. Three Rivers |
State: | MA US |
Postal Code: | 010801242 |
Phone Number: | 4132839715 |
Fax Number: | 4132838084 |
NPI Enumeration Date: | 02/13/2007 |
NPI Last Update Date: | 10/31/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 251G00000X |
License Number: | 2181 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Agencies |
Taxonomy Classification: | Hospice Care, Community Based |
Taxonomy Specialization: | |
Taxonomy Definition: |