1245403963 NPI number — MEDWAY COUNTRY MANOR, INC.

Table of content: (NPI 1245403963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245403963 NPI number — MEDWAY COUNTRY MANOR, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDWAY COUNTRY MANOR, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GENERATIONS OUTPATIENT WELLNESS & REHAB - SPEECH THERAPY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245403963
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 HOLLISTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDWAY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02053-1954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-533-9893
Provider Business Mailing Address Fax Number:
508-533-7048

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 HOLLISTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDWAY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02053-1954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-533-9893
Provider Business Practice Location Address Fax Number:
508-533-7048
Provider Enumeration Date:
04/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PETERS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
508-533-6634

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  0840 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0910481 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com