Provider Demographics
NPI:1770608341
Name:SUBURBAN HOME CARE MEDRIDE
Entity type:Organization
Organization Name:SUBURBAN HOME CARE MEDRIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-599-5200
Mailing Address - Street 1:1050 COMMONWEALTH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-1109
Mailing Address - Country:US
Mailing Address - Phone:781-599-5200
Mailing Address - Fax:781-592-7839
Practice Address - Street 1:1050 COMMONWEALTH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-1109
Practice Address - Country:US
Practice Address - Phone:781-599-5200
Practice Address - Fax:781-592-7839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1720767Medicaid