Basic Information
| Provider Information | |||||||||
| NPI: | 1073810594 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEWARD HOLY FAMILY HOSPITAL, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HOLY FAMILY PROFESSIONAL SERVCIES | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 70 EAST ST | ||||||||
| Address2: | |||||||||
| City: | METHUEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018444597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786870156 | ||||||||
| FaxNumber: | 9786871769 | ||||||||
| Practice Location | |||||||||
| Address1: | 70 EAST ST | ||||||||
| Address2: | |||||||||
| City: | METHUEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018444597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786870156 | ||||||||
| FaxNumber: | 9786871769 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2011 | ||||||||
| LastUpdateDate: | 02/18/2011 | ||||||||
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| AuthorizedOfficialLastName: | RICH | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6177892706 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | STEWARD HEALTH CARE SYSTEM LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.