Healthcare Provider Details

I. General information

NPI: 1588861231
Provider Name (Legal Business Name): NORTHEAST HOSPITAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 LINDALL ST THE HUNT CENTER
DANVERS MA
01923-2121
US

IV. Provider business mailing address

75 LINDALL ST THE HUNT CENTER
DANVERS MA
01923-2121
US

V. Phone/Fax

Practice location:
  • Phone: 978-774-4400
  • Fax: 978-646-7016
Mailing address:
  • Phone: 978-774-4400
  • Fax: 978-646-7016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number250378
License Number StateMA

VIII. Authorized Official

Name: MRS. KELLY E REILLY
Title or Position: DIABETES NURSE EDUCATOR
Credential: BSN, RN, CDE
Phone: 978-774-4400