Provider Demographics
NPI:1841471778
Name:LAZARUS HOUSE, INC.
Entity type:Organization
Organization Name:LAZARUS HOUSE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:H.
Authorized Official - Middle Name:BRIDGET
Authorized Official - Last Name:SHAHEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-269-5200
Mailing Address - Street 1:48 HOLLY ST
Mailing Address - Street 2:P.O. BOX 408
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-3538
Mailing Address - Country:US
Mailing Address - Phone:978-689-8575
Mailing Address - Fax:978-682-7004
Practice Address - Street 1:412 HAMPSHIRE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-3110
Practice Address - Country:US
Practice Address - Phone:978-269-5284
Practice Address - Fax:978-602-7004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4FUB261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental