=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356696603
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EAST VILLAGE PLACE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2012
-----------------------------------------------------
Last Update Date | 07/23/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 BENTON DR
-----------------------------------------------------
City | EAST LONGMEADOW
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01028-2772
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-525-1391
-----------------------------------------------------
Fax | 413-525-1207
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 BENTON DR
-----------------------------------------------------
City | EAST LONGMEADOW
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01028-2772
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-525-1391
-----------------------------------------------------
Fax | 413-525-1207
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OCCUPATIONAL THERAPIST
-----------------------------------------------------
Name | MRS. MARIE ELIZABETH NAPOLITAN
-----------------------------------------------------
Credential | OTR/L
-----------------------------------------------------
Telephone | 413-525-1391
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 3749
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------