Provider Demographics
NPI:1407827710
Name:NORTHEAST HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:NORTHEAST HOSPITAL CORPORATION
Other - Org Name:BEVERLY HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:CONROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-922-3000
Mailing Address - Street 1:85 HERRICK STREET
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:978-922-3000
Mailing Address - Fax:978-921-7048
Practice Address - Street 1:85 HERRICK STREET
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:978-922-3000
Practice Address - Fax:978-921-7048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15273R00000X
273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1202626Medicaid
MD2222003306OtherBC INDEM IP PSYCH
MA900082OtherTUFTS MCR HMO OUTPAT
MA901790OtherTUFTS IP PSYCH
MA1000039Medicaid
MA2222003311OtherBC HMO/PHO PSYCH OP
MA2222003325OtherBC OUTPAT INDEM PSYCH
MA9343OtherAETNA HMO PSYCH
MABEV2222003311OtherHMO BLUE PSYCH OP
MA0007079OtherNHP PSYCH
MA1898639Medicaid
MA2222003301OtherBC HMO/PHO PSYCH IP
MA900082OtherTUFTS OUTPAT PSYCH
MDBEV2222003301OtherHMO BLUE PSYCH IP
MA901790OtherTUFTS MCR HMO INPAT
MDS005394OtherCHAMPUS
MA903159OtherHARVARD PILGRIM PSYCH
MA2222003311OtherBC HMO/PHO PSYCH OP
MABEV2222003301Medicare ID - Type UnspecifiedMEDICARE EXTENSION