Provider Demographics
NPI:1760916654
Name:MSM GROUP INC
Entity Type:Organization
Organization Name:MSM GROUP INC
Other - Org Name:MASS STAR MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ASMATH
Authorized Official - Suffix:I
Authorized Official - Credentials:MBA
Authorized Official - Phone:617-820-9803
Mailing Address - Street 1:859 WILLARD ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7482
Mailing Address - Country:US
Mailing Address - Phone:800-985-5354
Mailing Address - Fax:800-985-5354
Practice Address - Street 1:859 WILLARD ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7482
Practice Address - Country:US
Practice Address - Phone:800-985-5354
Practice Address - Fax:800-985-5354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251E00000X, 347E00000X
MA3241251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1184Medicaid
MA1184Medicaid