Provider Demographics
NPI:1396037321
Name:HOSPICE PARTNERS OF THE NORTHEAST, LLC
Entity Type:Organization
Organization Name:HOSPICE PARTNERS OF THE NORTHEAST, LLC
Other - Org Name:FIDELIS HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:A
Authorized Official - Last Name:THAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-912-7842
Mailing Address - Street 1:25 RAILROAD SQ
Mailing Address - Street 2:SUITE 501
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832-5721
Mailing Address - Country:US
Mailing Address - Phone:978-912-7842
Mailing Address - Fax:
Practice Address - Street 1:25 RAILROAD SQ
Practice Address - Street 2:SUITE 501
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01832-5721
Practice Address - Country:US
Practice Address - Phone:978-912-7842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7KR5251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
221579Medicare Oscar/Certification