Provider Demographics
NPI:1225030315
Name:LIFE CARE AT HOME OF MASSACHUSETTS INC
Entity Type:Organization
Organization Name:LIFE CARE AT HOME OF MASSACHUSETTS INC
Other - Org Name:AFFINITY HOSPICE OF LIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-473-5257
Mailing Address - Street 1:3001 KEITH ST NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3713
Mailing Address - Country:US
Mailing Address - Phone:423-473-5256
Mailing Address - Fax:423-339-8356
Practice Address - Street 1:397 GROVE ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1223
Practice Address - Country:US
Practice Address - Phone:508-752-0827
Practice Address - Fax:508-755-3252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-02
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7A4Z251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110024496BMedicaid
MAAA13041OtherHARVARD PILGRIM
MAAA13041OtherHARVARD PILGRIM