Provider Demographics
NPI:1457657892
Name:COMMUNICARE, LLC
Entity Type:Organization
Organization Name:COMMUNICARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:NERISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MACCC-SLP
Authorized Official - Phone:978-621-7262
Mailing Address - Street 1:86 AMHERST RD
Mailing Address - Street 2:
Mailing Address - City:BELCHERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01007-9725
Mailing Address - Country:US
Mailing Address - Phone:978-621-7262
Mailing Address - Fax:413-213-0386
Practice Address - Street 1:360 SEWALL ST
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-2711
Practice Address - Country:US
Practice Address - Phone:413-875-5531
Practice Address - Fax:413-213-0386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-02
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7454235Z00000X
CT004233235Z00000X
MA6486235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110089850AMedicaid
MA110089776AMedicaid