Provider Demographics
NPI:1700300654
Name:NORTHEAST PROFESSIONAL REGISTRY OF NURSES INC
Entity Type:Organization
Organization Name:NORTHEAST PROFESSIONAL REGISTRY OF NURSES INC
Other - Org Name:LAHEY HEALTH AT HOME PALLIATIVE SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:978-712-1233
Mailing Address - Street 1:600 CUMMINGS CTR STE 270X
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6189
Mailing Address - Country:US
Mailing Address - Phone:978-921-2615
Mailing Address - Fax:978-921-1208
Practice Address - Street 1:600 CUMMINGS CTR STE 270X
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6189
Practice Address - Country:US
Practice Address - Phone:978-921-2615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHEAST PROFESSIONAL REGISTRY OF NURSES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110074458AMedicaid