Provider Demographics
NPI:1073658225
Name:NORTHEAST HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:NORTHEAST HOSPITAL CORPORATION
Other - Org Name:SPECTRUM ADULT DAY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CONROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-922-3000
Mailing Address - Street 1:85 HERRICK STREET
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:978-922-3000
Mailing Address - Fax:978-921-7048
Practice Address - Street 1:600 CUMMINGS CENTER
Practice Address - Street 2:SUITE 176X
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:978-921-5020
Practice Address - Fax:978-739-4627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1902997Medicaid