Provider Demographics
NPI:1902924384
Name:YOUVILLE HOSPITAL AND REHABILITATION
Entity type:Organization
Organization Name:YOUVILLE HOSPITAL AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PREASIDENT OF FINANCE CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-876-4344
Mailing Address - Street 1:1575 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4308
Mailing Address - Country:US
Mailing Address - Phone:617-876-4344
Mailing Address - Fax:617-234-7900
Practice Address - Street 1:100 BRICKSTONE SQ
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-1438
Practice Address - Country:US
Practice Address - Phone:617-876-4344
Practice Address - Fax:617-234-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA699902OtherTUFTS CLINIC PHYSICIANS
MA903902OtherTUFTS HOSPITAL PHYSICIAN
MA699902OtherTUFTS CLINIC PHYSICIANS