Provider Demographics
NPI:1245302439
Name:SISTERS OF PROVIDENCE CARE CENTERS, INC.
Entity type:Organization
Organization Name:SISTERS OF PROVIDENCE CARE CENTERS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIKO
Authorized Official - Middle Name:KIMURA
Authorized Official - Last Name:UMANA
Authorized Official - Suffix:
Authorized Official - Credentials:MED LMHA
Authorized Official - Phone:413-532-3246
Mailing Address - Street 1:35 HOLY FAMILY RD
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-2701
Mailing Address - Country:US
Mailing Address - Phone:413-532-3246
Mailing Address - Fax:413-532-0309
Practice Address - Street 1:35 HOLY FAMILY RD
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-2701
Practice Address - Country:US
Practice Address - Phone:413-532-3246
Practice Address - Fax:413-532-0309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0786314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0924237Medicaid
MA0924237Medicaid