Provider Demographics
NPI:1740250547
Name:SPAULDING REHABILITATION HOSPITAL CORPORATION
Entity type:Organization
Organization Name:SPAULDING REHABILITATION HOSPITAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-573-7152
Mailing Address - Street 1:8 TURCOTTE MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:ROWLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01969-1706
Mailing Address - Country:US
Mailing Address - Phone:800-488-4351
Mailing Address - Fax:978-356-2721
Practice Address - Street 1:1575 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4308
Practice Address - Country:US
Practice Address - Phone:617-573-7191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3932341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
806723OtherTUFTS HEALTH PLAN
MB3517OtherHEALTHNET OF NORTHEAST
VT0AM0139Medicaid
MA1720732Medicaid
702339OtherHARVARD PILGRIM
942551OtherCONNECTICARE
972771OtherNETWORK HEALTH
MA101859OtherBLUE CROSS BLUE SHIELD
P00190350OtherRR MEDICARE
NYWEK601OtherEMPIRE BLUE CROSS
000000025461OtherBMC HEALTHNET PLAN
0030497OtherNEIGHBORHOOD HEALTH