Provider Demographics
NPI:1437161163
Name:DIGITRACE CARE SERVICES, INC
Entity Type:Organization
Organization Name:DIGITRACE CARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE & ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-536-7400
Mailing Address - Street 1:200 CORPORATE PL
Mailing Address - Street 2:SUITE 5B
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-3840
Mailing Address - Country:US
Mailing Address - Phone:978-536-7400
Mailing Address - Fax:978-535-9757
Practice Address - Street 1:4710 W 95TH ST
Practice Address - Street 2:SUITE A6
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2546
Practice Address - Country:US
Practice Address - Phone:708-423-4693
Practice Address - Fax:708-423-5279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
7618325OtherAETNA
ILP00452102OtherRAILROAD MEDICARE
IL8011510OtherCIGNA
IL01619296OtherFEDERAL BCIL
IL215275Medicare PIN