Provider Demographics
NPI:1881636892
Name:GENESIS HEALTH VENTURES OF MASSACHUSETTS, INC.
Entity Type:Organization
Organization Name:GENESIS HEALTH VENTURES OF MASSACHUSETTS, INC.
Other - Org Name:HERITAGE HALL SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DROPESKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-925-4231
Mailing Address - Street 1:101 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-3109
Mailing Address - Country:US
Mailing Address - Phone:610-925-4436
Mailing Address - Fax:610-925-4351
Practice Address - Street 1:65 COOPER ST
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-2149
Practice Address - Country:US
Practice Address - Phone:413-786-8000
Practice Address - Fax:413-786-9788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0055314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000021319OtherBOSTON MEDICAL CENTER
MA0940224Medicaid
71-01265OtherUNITED - EVERCARE
7964490OtherCIGNA(HEALTHSOURCE OF MA)
MA2222517602OtherBC/BS - VENT
MA2222517610OtherBC/BS - OUTPATIENT REHAB
2462059OtherAETNA-HMO
0015749OtherNEIGHBORHOOD HEALTH PLAN
MD2222517601OtherBC/BS
2462059OtherAETNA-HMO
7964490OtherCIGNA(HEALTHSOURCE OF MA)
MA2222517610OtherBC/BS - OUTPATIENT REHAB