Provider Demographics
NPI:1497839641
Name:CARITAS HOLY FAMILY HOSPITAL-OUTPATIENT
Entity Type:Organization
Organization Name:CARITAS HOLY FAMILY HOSPITAL-OUTPATIENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE CONTACT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GUYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-687-0156
Mailing Address - Street 1:77 WARREN STREET
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPT
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135
Mailing Address - Country:US
Mailing Address - Phone:617-562-5482
Mailing Address - Fax:617-562-5415
Practice Address - Street 1:70 EAST ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-4597
Practice Address - Country:US
Practice Address - Phone:978-687-0156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1211439Medicaid
MA1211439Medicaid