Provider Demographics
NPI:1013134055
Name:ERICKSON LIVING HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:ERICKSON LIVING HEALTH SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-402-2323
Mailing Address - Street 1:300 LINDEN PONDS WAY
Mailing Address - Street 2:ATTN: EXECUTIVE DIRECTOR
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-0000
Mailing Address - Country:US
Mailing Address - Phone:781-534-7140
Mailing Address - Fax:410-204-7237
Practice Address - Street 1:203 LINDEN PONDS WAY
Practice Address - Street 2:ATTN: HOSPICE ADMINISTRATOR
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-8700
Practice Address - Country:US
Practice Address - Phone:781-534-7140
Practice Address - Fax:410-204-7237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA221598Medicare Oscar/Certification