Healthcare Provider Details

I. General information

NPI: 1679577175
Provider Name (Legal Business Name): THE NORTHEAST HEALTH GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 CHICOPEE ST
CHICOPEE MA
01013-2148
US

IV. Provider business mailing address

1675 PALM BEACH LAKES BLVD SUITE 900
WEST PALM BEACH FL
33401
US

V. Phone/Fax

Practice location:
  • Phone: 413-536-2540
  • Fax: 413-532-6445
Mailing address:
  • Phone: 561-801-7600
  • Fax: 414-268-4811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0835
License Number StateMA

VIII. Authorized Official

Name: HOWARD JAFFE
Title or Position: PRESIDENT
Credential:
Phone: 215-346-6454