Provider Demographics
NPI:1689709636
Name:SPRINGHOUSE, INC.
Entity Type:Organization
Organization Name:SPRINGHOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZIARZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-522-0043
Mailing Address - Street 1:44 ALLANDALE ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3449
Mailing Address - Country:US
Mailing Address - Phone:617-522-0043
Mailing Address - Fax:617-522-0893
Practice Address - Street 1:44 ALLANDALE ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3449
Practice Address - Country:US
Practice Address - Phone:617-522-0043
Practice Address - Fax:617-522-0893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1903292Medicaid