Provider Demographics
NPI:1194367086
Name:NORTH RIVER HOSPICE LLC
Entity Type:Organization
Organization Name:NORTH RIVER HOSPICE LLC
Other - Org Name:AUTUMN HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-771-2619
Mailing Address - Street 1:454 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-2050
Mailing Address - Country:US
Mailing Address - Phone:781-480-1445
Mailing Address - Fax:781-480-1440
Practice Address - Street 1:454 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-2050
Practice Address - Country:US
Practice Address - Phone:508-408-2408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2020-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based