Provider Demographics
NPI:1457685299
Name:HENRY HEYWOOD MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:HENRY HEYWOOD MEMORIAL HOSPITAL
Other - Org Name:HEYWOOD HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-630-6157
Mailing Address - Street 1:242 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-1336
Mailing Address - Country:US
Mailing Address - Phone:978-632-3420
Mailing Address - Fax:978-630-6596
Practice Address - Street 1:242 GREEN ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-1336
Practice Address - Country:US
Practice Address - Phone:978-632-3420
Practice Address - Fax:978-630-6596
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH CENTRAL HEALTHCARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-28
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20362084P0805X, 273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes273R00000XHospital UnitsPsychiatric Unit
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1000306Medicaid
MA1200739Medicaid
MA22S095Medicare UPIN