Provider Demographics
NPI:1134113608
Name:D'YOUVILLE SENIOR CARE, INC.
Entity Type:Organization
Organization Name:D'YOUVILLE SENIOR CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:ALTENWEG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-569-1054
Mailing Address - Street 1:981 VARNUM AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-1913
Mailing Address - Country:US
Mailing Address - Phone:978-569-1054
Mailing Address - Fax:978-569-1085
Practice Address - Street 1:981 VARNUM AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-1913
Practice Address - Country:US
Practice Address - Phone:978-569-1054
Practice Address - Fax:978-569-1085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0999547Medicaid
MA225515Medicare Oscar/Certification