Provider Demographics
NPI:1700138112
Name:MERRIMACK VALLEY HOSPICE, INC.
Entity Type:Organization
Organization Name:MERRIMACK VALLEY HOSPICE, INC.
Other - Org Name:YORK HOSPITAL HOSPICE & PALLIATIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-337-7333
Mailing Address - Street 1:127 LONG SANDS RD
Mailing Address - Street 2:#12
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:127 LONG SANDS RD
Practice Address - Street 2:#12
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1158
Practice Address - Country:US
Practice Address - Phone:207-337-7333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME37618251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1700138112Medicaid