NPIMap

Organization Active NPI

Cedardale Inc.

  • Health Service Clinic/Center
  • Haverhill, MA
National Provider Identifier
1104229574
Registry record updated Dec 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
License
000003634 Issued in MA
Legal business name
CEDARDALE INC.
Practice address
931 Boston Rd
Haverhill, MA 01835-6927
Phone
(978) 373-1596
NPI assigned
Sep 30, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Judy Wentworth
Title
Controller
Phone
(978) 373-1596

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X 000003634 MA Primary

Addresses

Primary practice location

931 Boston Rd
Haverhill, MA 01835-6927

Mailing address

931 Boston Rd
Haverhill, MA 01835-6927
Phone (978) 373-1596

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220706000297 MA Part B Supplier - Clinic/Group Practice 8729468996 Receives reassigned benefits from 2 practitioners
Practice locations: Haverhill, MA

National Provider Directory

National Provider Directory

Locations

931 Boston Rd
Haverhill, MA 01835
Phone (978) 373-1596

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1412035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419292800000",
    "number": "1104229574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "931 BOSTON RD",
            "city": "HAVERHILL",
            "state": "MA",
            "postal_code": "018356927",
            "telephone_number": "978-373-1596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "931 BOSTON RD",
            "city": "HAVERHILL",
            "state": "MA",
            "postal_code": "018356927",
            "telephone_number": "978-373-1596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDARDALE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-30",
        "last_updated": "2014-12-23",
        "status": "A",
        "authorized_official_last_name": "WENTWORTH",
        "authorized_official_first_name": "JUDY",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "978-373-1596"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "MA",
            "license": "000003634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Haverhill, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.