Healthcare Provider Details

I. General information

NPI: 1336452010
Provider Name (Legal Business Name): STEWARD HOLY FAMILY HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 EAST ST 2ND FLOOR
METHUEN MA
01844-4597
US

IV. Provider business mailing address

70 EAST ST 2ND FLOOR
METHUEN MA
01844-4597
US

V. Phone/Fax

Practice location:
  • Phone: 978-687-0151
  • Fax: 617-562-7241
Mailing address:
  • Phone: 978-687-0151
  • Fax: 617-562-7241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier110087057D
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: JAMES RENNA
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 617-419-4700