Provider Demographics
NPI:1225256563
Name:LASALLE HEALTH SERVICE INC
Entity Type:Organization
Organization Name:LASALLE HEALTH SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:F
Authorized Official - Last Name:LOMBARDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-699-2090
Mailing Address - Street 1:652 E WASHINGTON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-2459
Mailing Address - Country:US
Mailing Address - Phone:508-699-2090
Mailing Address - Fax:
Practice Address - Street 1:24 MAZZEO DR.
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-1653
Practice Address - Country:US
Practice Address - Phone:781-331-8696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0129750003Medicare NSC