Provider Demographics
NPI:1508959024
Name:NEW ENGLAND DEACONESS ASSOCIATION
Entity Type:Organization
Organization Name:NEW ENGLAND DEACONESS ASSOCIATION
Other - Org Name:ROCKRIDGE@LAUREL PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/VISE PRESIDENT O
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOLTOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-369-5151
Mailing Address - Street 1:80 DEACONESS ROAD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-4113
Mailing Address - Country:US
Mailing Address - Phone:978-369-5151
Mailing Address - Fax:978-371-1755
Practice Address - Street 1:25 COLES MEADOW ROAD
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3191
Practice Address - Country:US
Practice Address - Phone:978-369-5151
Practice Address - Fax:978-371-1755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1297313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5501253Medicaid