Provider Demographics
NPI:1558587584
Name:MAINSTAY SUPPORTIVE HOUSING AND HOME CARE, INC.
Entity type:Organization
Organization Name:MAINSTAY SUPPORTIVE HOUSING AND HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SODERHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:781-697-4662
Mailing Address - Street 1:29 CRAFTS ST STE 260
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1396
Mailing Address - Country:US
Mailing Address - Phone:617-789-4500
Mailing Address - Fax:617-789-5750
Practice Address - Street 1:100 BELLINGHAM ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-3358
Practice Address - Country:US
Practice Address - Phone:617-884-6333
Practice Address - Fax:617-884-3247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110032782DMedicaid