Provider Demographics
NPI:1356328140
Name:ALLIANCE HEALTH OF MASSACHUSETTS INC
Entity Type:Organization
Organization Name:ALLIANCE HEALTH OF MASSACHUSETTS INC
Other - Org Name:ALLIANCE HEALTH AT ROSEWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-348-2001
Mailing Address - Street 1:22 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2311
Mailing Address - Country:US
Mailing Address - Phone:978-535-8700
Mailing Address - Fax:978-535-2300
Practice Address - Street 1:22 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960
Practice Address - Country:US
Practice Address - Phone:978-535-8700
Practice Address - Fax:978-535-2300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0975314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0926159Medicaid
MA0926159Medicaid
MA225651Medicare Oscar/Certification