Provider Demographics
NPI:1083733307
Name:ELDER SERVICES OF THE MERRIMACK VALLEY, INC.
Entity Type:Organization
Organization Name:ELDER SERVICES OF THE MERRIMACK VALLEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DISTEFANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-683-7747
Mailing Address - Street 1:280 MERRIMACK ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1779
Mailing Address - Country:US
Mailing Address - Phone:978-683-7747
Mailing Address - Fax:978-687-1067
Practice Address - Street 1:280 MERRIMACK ST
Practice Address - Street 2:SUITE 400
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1779
Practice Address - Country:US
Practice Address - Phone:978-683-7747
Practice Address - Fax:978-687-1067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1900609OtherMASS HEALTH - GAFC