Provider Demographics
NPI:1508111790
Name:IHS OF MASSACHUSETTS, LLC
Entity Type:Organization
Organization Name:IHS OF MASSACHUSETTS, LLC
Other - Org Name:ADVANCED KIDNEY THERAPIES OF FOXBORO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:617-328-7707
Mailing Address - Street 1:6001 BROKEN SOUND PKWY
Mailing Address - Street 2:SUITE 502
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2765
Mailing Address - Country:US
Mailing Address - Phone:561-443-0743
Mailing Address - Fax:561-443-7296
Practice Address - Street 1:10 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:FOXBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:02035-1382
Practice Address - Country:US
Practice Address - Phone:617-328-7707
Practice Address - Fax:617-328-7787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110091529CMedicaid
MA110091529CMedicaid