Provider Demographics
NPI:1740519057
Name:MAS MEDICAL STAFFING CORPORATION
Entity type:Organization
Organization Name:MAS MEDICAL STAFFING CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-232-0972
Mailing Address - Street 1:156 HARVEY RD
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-7449
Mailing Address - Country:US
Mailing Address - Phone:603-232-0972
Mailing Address - Fax:
Practice Address - Street 1:30 SUMMER ST
Practice Address - Street 2:SUITE 5
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6467
Practice Address - Country:US
Practice Address - Phone:207-561-9533
Practice Address - Fax:207-561-9538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME37952251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health