Healthcare Provider Details

I. General information

NPI: 1073658225
Provider Name (Legal Business Name): NORTHEAST HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CUMMINGS CENTER SUITE 176X
BEVERLY MA
01915
US

IV. Provider business mailing address

85 HERRICK STREET MEDICAL STAFF OFFICE
BEVERLY MA
01915
US

V. Phone/Fax

Practice location:
  • Phone: 978-921-5020
  • Fax: 978-739-4627
Mailing address:
  • Phone: 978-922-3000
  • Fax: 978-921-7048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DENIS CONROY
Title or Position: CEO
Credential:
Phone: 978-922-3000