Provider Demographics
NPI:1366582090
Name:NORTH SHORE COMMUNITY HEALTH, INC
Entity type:Organization
Organization Name:NORTH SHORE COMMUNITY HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:978-825-1109
Mailing Address - Street 1:27 CONGRESS ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-7309
Mailing Address - Country:US
Mailing Address - Phone:978-744-8388
Mailing Address - Fax:978-744-0079
Practice Address - Street 1:27 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-7309
Practice Address - Country:US
Practice Address - Phone:978-744-8388
Practice Address - Fax:978-744-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4M9K261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110027881AMedicaid
MA110027881BMedicaid
MA110027881DMedicaid
MA221817Medicare Oscar/Certification
MAY10345Medicare UPIN