Provider Demographics
NPI:1568450815
Name:1976 STEVENS-BENNET HOME INC
Entity Type:Organization
Organization Name:1976 STEVENS-BENNET HOME INC
Other - Org Name:1856 LADIES CHARITABLE ASSOCIATION OF HAVERNILL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KELLEHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-374-8861
Mailing Address - Street 1:337 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-4054
Mailing Address - Country:US
Mailing Address - Phone:978-374-8861
Mailing Address - Fax:978-374-2109
Practice Address - Street 1:337 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-4054
Practice Address - Country:US
Practice Address - Phone:978-374-8861
Practice Address - Fax:978-374-2109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5500192Medicaid