Provider Demographics
NPI:1841290467
Name:MELROSEWAKEFIELD HEALTHCARE, INC.
Entity type:Organization
Organization Name:MELROSEWAKEFIELD HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-887-1439
Mailing Address - Street 1:170 GOVERNORS AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-1643
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:170 GOVERNORS AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-1643
Practice Address - Country:US
Practice Address - Phone:781-979-3050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAVKB3282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1000403Medicaid
MA900147OtherHP LAWRENCE ALL
MA900262OtherHP MELROSE ALL
MA0018036OtherNHP ALL
MA0018183OtherNHP FHC
MA1004805OtherNHP PSYCH OP
MA2222007030OtherBC SDC
MA2222007001OtherBC INPATIENT
MA900012OtherTUFTS LAWRENCE INPATIENT
MA905174OtherTUFTS MELROSE OUTPATIENT
MA996129OtherNETWORK ALL
MA1903241Medicaid
MA905178OtherTUFTS MALDEN AND FHC
MA2222007010OtherBC OUTPATIENT
MA905173OtherTUFTS MELROSE INPATIENT
MA1211382Medicaid
MA1200992Medicaid
MA900005OtherTUFTS LAWRENCE OUTPATIENT
MA900348OtherHP MALDEN
MA220070Medicare Oscar/Certification