Basic Information
| Provider Information | |||||||||
| NPI: | 1083199749 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEW ENGLAND HOSPICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 65 KINGLAND RD | ||||||||
| Address2: | |||||||||
| City: | STOW | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017751510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7745735227 | ||||||||
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| Practice Location | |||||||||
| Address1: | 190 OLD DERBY ST STE 304 | ||||||||
| Address2: | |||||||||
| City: | HINGHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020434065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817492900 | ||||||||
| FaxNumber: | 7817492950 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2018 | ||||||||
| LastUpdateDate: | 09/28/2018 | ||||||||
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| AuthorizedOfficialLastName: | BURGOS | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | MSW | ||||||||
| AuthorizedOfficialTelephone: | 7745735227 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LICSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 0609510 | 05 | MA | MEDICAID |