Jeremiah'S Inn Inc.

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

0290 Issued in MA

Legal business name

JEREMIAH'S INN INC.

Practice address

1059 Main St
Worcester, MA 01603-2421

Phone

(508) 755-6403

Fax

(508) 793-9568

NPI assigned

Jan 13, 2017

Organization subpart

No

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

Authorized official

Name

Ms. Melissa Ann Waddell

Title

Communications Coordinator

Phone

(508) 755-6403

Specialties & licenses 1

Addresses

Other names 1

• Jeremiah's Hospice Former legal business name

Locations

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

{
    "created_epoch": "1484265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484265600000",
    "number": "1679019731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1059 MAIN ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016032421",
            "telephone_number": "508-755-6403",
            "fax_number": "508-793-9568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1059 MAIN ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016032421",
            "telephone_number": "508-755-6403",
            "fax_number": "508-793-9568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEREMIAH'S INN INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-13",
        "last_updated": "2017-01-13",
        "status": "A",
        "authorized_official_last_name": "WADDELL",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "COMMUNICATIONS COORDINATOR",
        "authorized_official_telephone_number": "508-755-6403",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "MA",
            "license": "0290",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jeremiah's Hospice",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Substance Abuse Rehabilitation Facility in Worcester, MA
• Providers in Worcester, MA by specialty
• Substance Abuse Rehabilitation Facility in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2017; 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.