Provider Demographics
NPI:1821092263
Name:THE NORTHEAST HEALTH GROUP, INC
Entity Type:Organization
Organization Name:THE NORTHEAST HEALTH GROUP, INC
Other - Org Name:WILLIMANSETT CENTER EAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-346-6454
Mailing Address - Street 1:1675 PALM BEACH LAKES BLVD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401
Mailing Address - Country:US
Mailing Address - Phone:561-801-7600
Mailing Address - Fax:414-268-4811
Practice Address - Street 1:11 SAINT ANTHONY ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-2141
Practice Address - Country:US
Practice Address - Phone:413-536-2540
Practice Address - Fax:413-552-3426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0733314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0922463Medicaid
MA225249Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER