Provider Demographics
NPI:1821399627
Name:ATHENA HOSPICE SERVICES OF WESTERN MASSACHUSETTS, LLC
Entity Type:Organization
Organization Name:ATHENA HOSPICE SERVICES OF WESTERN MASSACHUSETTS, LLC
Other - Org Name:HOSPICE SERVICES OF WESTERN MASSACHUSETTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOSIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-751-3900
Mailing Address - Street 1:135 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2556
Mailing Address - Country:US
Mailing Address - Phone:860-751-3900
Mailing Address - Fax:860-751-3905
Practice Address - Street 1:1325 SPRINGFIELD ST STE 12
Practice Address - Street 2:
Practice Address - City:FEEDING HILLS
Practice Address - State:MA
Practice Address - Zip Code:01030-2150
Practice Address - Country:US
Practice Address - Phone:413-786-4004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATHENA HEALTH CARE ASSOCIATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-10
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7J8P251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110087949AMedicaid
MA221576Medicare Oscar/Certification