=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215119037
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENESIS HEALTH VENTURES OF MASSACHUSETTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2007
-----------------------------------------------------
Last Update Date | 11/11/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 462 MAIN ST
-----------------------------------------------------
City | AGAWAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01001-1833
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-786-9704
-----------------------------------------------------
Fax | 413-789-8366
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 E STATE ST
-----------------------------------------------------
City | KENNETT SQUARE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19348-3109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-925-4436
-----------------------------------------------------
Fax | 610-925-4351
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CORPORATE DIRECTOR
-----------------------------------------------------
Name | JANE DROPESKEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 610-925-4231
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | N/A
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------