=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568275196
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLIANCE HEALTH OF NORTHBOROUGH INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2025
-----------------------------------------------------
Last Update Date | 01/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112 W MAIN ST
-----------------------------------------------------
City | NORTHBOROUGH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01532-1824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-351-9355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 144 TURNPIKE RD STE 220
-----------------------------------------------------
City | SOUTHBOROUGH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01772-2139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-348-2000
-----------------------------------------------------
Fax | 774-849-4214
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | PAUL B KEMP
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 774-348-2001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------