Provider Demographics
NPI:1700818200
Name:SISTERS OF PROVIDENCE INC , INFIRMARY
Entity Type:Organization
Organization Name:SISTERS OF PROVIDENCE INC , INFIRMARY
Other - Org Name:SISTERS OF PROVIDENCE INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:CAHILLANE
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:1413-493-2752
Mailing Address - Street 1:1233 MAIN ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-5381
Mailing Address - Country:US
Mailing Address - Phone:141-349-3275
Mailing Address - Fax:141-349-3275
Practice Address - Street 1:1233 MAIN ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-5381
Practice Address - Country:US
Practice Address - Phone:141-349-3275
Practice Address - Fax:141-349-3275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA31400000X314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0923966Medicaid
MA314M00000XOtherSKILLED NURSING FACILITY
MA314M00000XOtherSKILLED NURSING FACILITY