Basic Information
| Provider Information | |||||||||
| NPI: | 1457447286 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARITAS GOOD SAMARITAN MEDICAL CENTER-THEGODDARD CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 77 WARREB STREET | ||||||||
| Address2: | PROVIDER ENROLLMENT DEPT | ||||||||
| City: | BRIGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175625359 | ||||||||
| FaxNumber: | 6175625415 | ||||||||
| Practice Location | |||||||||
| Address1: | 909 SUMNER ST | ||||||||
| Address2: | |||||||||
| City: | STOUGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020723396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084273668 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BURNS | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5084272217 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1210009 | 05 | MA | MEDICAID |