Provider Demographics
NPI:1689669822
Name:AGE INSTITUTE OF MASSACHUSETTS, INC.
Entity Type:Organization
Organization Name:AGE INSTITUTE OF MASSACHUSETTS, INC.
Other - Org Name:HAMPDEN HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:N
Authorized Official - Last Name:HEINZE
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, NHA
Authorized Official - Phone:413-737-4756
Mailing Address - Street 1:190 KENDALL ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2532
Mailing Address - Country:US
Mailing Address - Phone:413-733-6617
Mailing Address - Fax:413-733-9269
Practice Address - Street 1:190 KENDALL ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2532
Practice Address - Country:US
Practice Address - Phone:413-733-6617
Practice Address - Fax:413-733-9269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA858310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5508193Medicaid
=========OtherEIN