Provider Demographics
NPI:1861662017
Name:ATHENA NURSING PLACEMENT JOINT VENTURE, LLC
Entity Type:Organization
Organization Name:ATHENA NURSING PLACEMENT JOINT VENTURE, LLC
Other - Org Name:ATHENA HOME HEALTH OF MASSACHUSETTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:G
Authorized Official - Last Name:SANTILLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-751-3900
Mailing Address - Street 1:10 RIVERSIDE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-1689
Mailing Address - Country:US
Mailing Address - Phone:508-673-5500
Mailing Address - Fax:508-673-6500
Practice Address - Street 1:10 RIVERSIDE DR STE 201
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MA
Practice Address - Zip Code:02347-1689
Practice Address - Country:US
Practice Address - Phone:508-673-5500
Practice Address - Fax:508-673-6500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATHENA HEALTH CARE ASSOCIATES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-04
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110130396AMedicaid