Provider Demographics
NPI:1164477055
Name:4499 ACUSHNET AVENUE OPERATING COMPANY, LLC
Entity type:Organization
Organization Name:4499 ACUSHNET AVENUE OPERATING COMPANY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOLLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-591-5700
Mailing Address - Street 1:4499 ACUSHNET AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02745-4707
Mailing Address - Country:US
Mailing Address - Phone:508-995-6900
Mailing Address - Fax:508-998-5974
Practice Address - Street 1:4499 ACUSHNET AVE
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-4707
Practice Address - Country:US
Practice Address - Phone:508-995-6900
Practice Address - Fax:508-985-9615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA079282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA982810OtherTUFTS INPATIENT
MA2222204301OtherBLUE CROSS INPATIENT
MA982813OtherTUFTS OUTPATIENT
MA1100548Medicaid
MA2222204310OtherBLUE CROSS (OUTPATIENT)
MA5000016OtherUNITED HEALTH
MA1100556Medicaid
MA1213393Medicaid
MA903949OtherHARVARD PILGRIM
MA903949OtherHARVARD PILGRIM
MA22-2043Medicare Oscar/Certification