Provider Demographics
NPI:1124062740
Name:SOLAMOR HOSPICE CORPORATION
Entity type:Organization
Organization Name:SOLAMOR HOSPICE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CAVALLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-996-5900
Mailing Address - Street 1:123 WATERHOUSE ROAD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BOURNE
Mailing Address - State:MA
Mailing Address - Zip Code:02532-3890
Mailing Address - Country:US
Mailing Address - Phone:508-743-0203
Mailing Address - Fax:508-743-0249
Practice Address - Street 1:123 WATERHOUSE ROAD
Practice Address - Street 2:SUITE 5
Practice Address - City:BOURNE
Practice Address - State:MA
Practice Address - Zip Code:02532-3890
Practice Address - Country:US
Practice Address - Phone:508-743-0203
Practice Address - Fax:508-743-0249
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOLAMOR HOSPICE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-15
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251G00000X
MA7ADX251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110024507GMedicaid
MA0608076Medicaid
MA0608076Medicaid