Provider Demographics
NPI:1578864377
Name:ATHENA HOSPICE SERVICES OF MASSACHUSETTS, LLC
Entity Type:Organization
Organization Name:ATHENA HOSPICE SERVICES OF MASSACHUSETTS, LLC
Other - Org Name:HOSPICE SERVICES OF MASSACHUSETTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:G
Authorized Official - Last Name:SANTILLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-751-3900
Mailing Address - Street 1:10 RIVERSIDE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-1689
Mailing Address - Country:US
Mailing Address - Phone:508-291-0049
Mailing Address - Fax:508-291-6004
Practice Address - Street 1:10 RIVERSIDE DR STE 201
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MA
Practice Address - Zip Code:02347-1689
Practice Address - Country:US
Practice Address - Phone:508-291-0049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATHENA HEALTH CARE ASSOCIATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-10
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7J03251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110087953AMedicaid
MA221570Medicare Oscar/Certification