Provider Demographics
NPI:1336675263
Name:WEST RIVER HOSPICE LLC
Entity Type:Organization
Organization Name:WEST RIVER HOSPICE LLC
Other - Org Name:WEST RIVER HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VP AND CLEERK
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:GENERAL COUNSEL
Authorized Official - Phone:781-707-9075
Mailing Address - Street 1:63 KENDRICK ST
Mailing Address - Street 2:ONE CHARLES RIVER PLACE
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-2708
Mailing Address - Country:US
Mailing Address - Phone:781-707-9578
Mailing Address - Fax:781-281-8457
Practice Address - Street 1:63 KENDRICK ST
Practice Address - Street 2:ONE CHARLES RIVER PLACE
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-2708
Practice Address - Country:US
Practice Address - Phone:781-707-9578
Practice Address - Fax:781-281-8457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7J02251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based