Basic Information
| Provider Information | |||||||||
| NPI: | 1558496323 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW ENGLAND HOSPICE II LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NEW ENGLAND HOSPICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 190 OLD DERBY STREET | ||||||||
| Address2: | STE 304 | ||||||||
| City: | HINGHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817492900 | ||||||||
| FaxNumber: | 7817492950 | ||||||||
| Practice Location | |||||||||
| Address1: | 190 OLD DERBY STREET | ||||||||
| Address2: | STE 304 | ||||||||
| City: | HINGHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817492900 | ||||||||
| FaxNumber: | 7817492950 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2007 | ||||||||
| LastUpdateDate: | 02/06/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ESTEY | ||||||||
| AuthorizedOfficialFirstName: | GREGG | ||||||||
| AuthorizedOfficialMiddleName: | ALLEN | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7815447723 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PGM HEALTHCARE INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 221563 | MA | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 0609510 | 05 | MA | MEDICAID |