Provider Demographics
NPI:1669454955
Name:LOOMIS HOUSE, INC
Entity Type:Organization
Organization Name:LOOMIS HOUSE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:R
Authorized Official - Last Name:MANTONI
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:413-532-5325
Mailing Address - Street 1:298 JARVIS AVE
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-1288
Mailing Address - Country:US
Mailing Address - Phone:413-538-7551
Mailing Address - Fax:413-532-8676
Practice Address - Street 1:298 JARVIS AVE
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-1288
Practice Address - Country:US
Practice Address - Phone:413-538-7551
Practice Address - Fax:413-532-8676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0855314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0913316Medicaid
MA0913316Medicaid