Basic Information
| Provider Information | |||||||||
| NPI: | 1992707178 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YOUVILLE HOSPITAL & REHABILITATION CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1575 CAMBRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021384308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178764344 | ||||||||
| FaxNumber: | 6172347913 | ||||||||
| Practice Location | |||||||||
| Address1: | 1575 CAMBRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021384308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178764344 | ||||||||
| FaxNumber: | 6172347913 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2005 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | KELLER | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | VP OF FINANCE/CFO | ||||||||
| AuthorizedOfficialTelephone: | 6178764344 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CFO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282E00000X | Y | Hospitals | Long Term Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 900582 | 01 | MA | HARVARD COMMUNITY HEALTH | OTHER | CA7049 | 01 | MA | MEDICARE RAILROAD | OTHER | 2222200002 | 01 | MA | REHABILITATION INPATIENT | OTHER | 30014212 | 05 | NH | MEDICAID | 0222000 | 05 | RI | MEDICAID | 1103105 | 05 | MA | MEDICAID | 905169 | 01 | MA | TUFTS HEALTH PLAN INPT NO | OTHER | 996006 | 01 | MA | NETWORK HEALTH | OTHER |