Provider Demographics
NPI:1679657837
Name:CARITAS CARNEY HOSPITAL
Entity Type:Organization
Organization Name:CARITAS CARNEY HOSPITAL
Other - Org Name:CARITAS CARNEY OP CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GUYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-789-2204
Mailing Address - Street 1:795 MIDDLE ST
Mailing Address - Street 2:SAINT ANNE'S HOSPITAL
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-1733
Mailing Address - Country:US
Mailing Address - Phone:508-674-5741
Mailing Address - Fax:508-235-5330
Practice Address - Street 1:2100 DORCHESTER AVE
Practice Address - Street 2:CARITAS CARNEY HOSPITAL
Practice Address - City:DORCHESTER CENTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5615
Practice Address - Country:US
Practice Address - Phone:617-296-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARITAS CARNEY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-24
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1212508Medicaid
MA220017Medicare ID - Type Unspecified