Healthcare Provider Details

I. General information

NPI: 1689685257
Provider Name (Legal Business Name): NORTH HILL NEEDHAM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 CENTRAL AVE
NEEDHAM MA
02492-1316
US

IV. Provider business mailing address

865 CENTRAL AVE
NEEDHAM MA
02492-1316
US

V. Phone/Fax

Practice location:
  • Phone: 781-444-9910
  • Fax: 781-453-8675
Mailing address:
  • Phone: 781-444-9910
  • Fax: 781-453-8675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0868
License Number StateMA

VII. Legacy identifiers

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

# 1
Identifier802793
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerTUFTS ID
# 2
Identifier0915335
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 3
Identifier2222528101
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBLUE CROSS BLUE SHIELD

VIII. Authorized Official

Name: ADAM GOLDMAN
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 781-433-6215