Provider Demographics
NPI:1518009273
Name:BAYSTATE WING HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:BAYSTATE WING HOSPITAL CORPORATION
Other - Org Name:BAYSTATE WING HOSPITAL: VISITING NURSE ASSOCIATION & HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER & CFO
Authorized Official - Prefix:
Authorized Official - First Name:KEARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:ALLICON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-284-5302
Mailing Address - Street 1:40 WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:MA
Mailing Address - Zip Code:01069-1138
Mailing Address - Country:US
Mailing Address - Phone:413-283-9715
Mailing Address - Fax:413-283-8084
Practice Address - Street 1:4 SPRINGFIELD ST., BLDG. 3, 4TH FL.
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MA
Practice Address - Zip Code:01080-1242
Practice Address - Country:US
Practice Address - Phone:413-283-9715
Practice Address - Fax:413-283-8084
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAYSTATE WING HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-12
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2181251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0608149Medicaid
981443OtherNETWORK HEALTH
804738OtherTUFTS HEALTH PLAN
18354OtherHEALTH NEW ENGLAND
MA120116OtherBLUECROSSBLUESHIELD
702265OtherHARVARD PILGRIM HLTH CARE
227116Medicare Oscar/Certification