Colonial Health Group - Everett, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0340 Issued in MA

Legal business name

COLONIAL HEALTH GROUP - EVERETT, LLC

Practice address

289 Elm St
Everett, MA 02149

Phone

(617) 387-6560

Fax

(617) 387-2885

NPI assigned

Jun 7, 2006

Organization subpart

No

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

Authorized official

Name

Laura R McDonnell

Title

Manager

Phone

(978) 420-1500

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Everett Nursing and Rehabilitation Center Doing business as

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195430400000",
    "number": "1487694972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 AVCO RD",
            "city": "HAVERHILL",
            "state": "MA",
            "postal_code": "01835",
            "telephone_number": "617-387-6560",
            "fax_number": "617-387-2885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "289 ELM ST",
            "city": "EVERETT",
            "state": "MA",
            "postal_code": "02149",
            "telephone_number": "617-387-6560",
            "fax_number": "617-387-2885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLONIAL HEALTH GROUP - EVERETT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-07",
        "last_updated": "2007-11-19",
        "status": "A",
        "authorized_official_last_name": "MCDONNELL",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "978-420-1500"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MA",
            "license": "0340",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE",
            "identifier": "7180208",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0920061",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ELDER SERVICE PLAN",
            "identifier": "0000002254",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Everett Nursing and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Laura Jean Clarke
• Philip A. Clater, PA-C
• Heather E Coates-Krawitz, MD
• Michael J Cognata, DMD
• Staci Coleman
• Alexandra Colpack
• Amanda Connolly, LICSW
• Sean Fitzpatrick Connolly Sr., DPM
• Taylor Leroy Connolly, LMHC
• Lynda Lee Consolo

• Skilled Nursing Facility in Everett, MA
• Providers in Everett, MA by specialty
• Skilled Nursing Facility in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.