Provider Demographics
NPI:1588861231
Name:NORTHEAST HOSPITAL CORP.
Entity type:Organization
Organization Name:NORTHEAST HOSPITAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIABETES NURSE EDUCATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:E
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN, CDE
Authorized Official - Phone:978-774-4400
Mailing Address - Street 1:75 LINDALL ST
Mailing Address - Street 2:THE HUNT CENTER
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-2121
Mailing Address - Country:US
Mailing Address - Phone:978-774-4400
Mailing Address - Fax:978-646-7016
Practice Address - Street 1:75 LINDALL ST
Practice Address - Street 2:THE HUNT CENTER
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2121
Practice Address - Country:US
Practice Address - Phone:978-774-4400
Practice Address - Fax:978-646-7016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA250378163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty