Provider Demographics
NPI:1710973474
Name:110 MONASTERY ASSOCIATES LP
Entity Type:Organization
Organization Name:110 MONASTERY ASSOCIATES LP
Other - Org Name:LANDMARK AT MONASTERY HEIGHTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRERAR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:413-781-1282
Mailing Address - Street 1:110 MONASTERY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-1541
Mailing Address - Country:US
Mailing Address - Phone:413-781-1282
Mailing Address - Fax:413-781-2182
Practice Address - Street 1:110 MONASTERY AVE
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1541
Practice Address - Country:US
Practice Address - Phone:413-781-1282
Practice Address - Fax:413-781-2182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA310400000X, 311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1905121OtherMASS HEALTH PROVIDER #