Healthcare Provider Details

I. General information

NPI: 1386648889
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: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 KENDALL ST
SPRINGFIELD MA
01104-2532
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: 413-737-4756
  • Fax: 413-737-1169
Mailing address:
  • Phone: 561-801-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2844
License Number StateMA

VII. Legacy identifiers

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

# 1
Identifier0922457
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

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