Provider Demographics
NPI:1376530089
Name:ALLIANCE HEALTH OF QUINCY, INC.
Entity Type:Organization
Organization Name:ALLIANCE HEALTH OF QUINCY, INC.
Other - Org Name:ALLIANCE HEALTH AT MARINA BAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
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 1:2 SEAPORT DRIVE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-1599
Mailing Address - Country:US
Mailing Address - Phone:617-769-5100
Mailing Address - Fax:617-786-8812
Practice Address - Street 1:2 SEAPORT DR
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-1599
Practice Address - Country:US
Practice Address - Phone:617-769-5100
Practice Address - Fax:617-472-8427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0542314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110026579AMedicaid
MA0926230Medicaid
MA0926230Medicaid