Provider Demographics
NPI:1023431145
Name:CELTICARE HEALTH PLAN OF MASSACHUSETTS, INC.
Entity type:Organization
Organization Name:CELTICARE HEALTH PLAN OF MASSACHUSETTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. DIRECTOR, ETHICS AND COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOHLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN, MSML
Authorized Official - Phone:770-743-3252
Mailing Address - Street 1:200 WEST ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1121
Mailing Address - Country:US
Mailing Address - Phone:617-779-5100
Mailing Address - Fax:
Practice Address - Street 1:200 WEST ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1121
Practice Address - Country:US
Practice Address - Phone:617-779-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTENE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization