Provider Demographics
NPI:1669436507
Name:HELLENIC WOMENS BENEVOLENT ASSOCIATION INC
Entity type:Organization
Organization Name:HELLENIC WOMENS BENEVOLENT ASSOCIATION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-828-7450
Mailing Address - Street 1:601 SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2025
Mailing Address - Country:US
Mailing Address - Phone:781-828-7450
Mailing Address - Fax:
Practice Address - Street 1:601 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2025
Practice Address - Country:US
Practice Address - Phone:781-828-7450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA874314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA904351OtherHPHC
MA805073OtherSECURE HORIZONS
MA0910996Medicaid
MA225418Medicare ID - Type UnspecifiedLONG-TERM CARE