1477637270 NPI number — WILLOWOOD OF WILLIAMSTOWN, INC.

Table of content: (NPI 1477637270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477637270 NPI number — WILLOWOOD OF WILLIAMSTOWN, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLOWOOD OF WILLIAMSTOWN, 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:
WILLIAMSTOWN COMMONS NURSING & REHABILITATION CENTER
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:
1477637270
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 ADAMS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSTOWN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01267-2928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-458-2111
Provider Business Mailing Address Fax Number:
413-458-3156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 ADAMS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSTOWN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01267-2928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-458-2111
Provider Business Practice Location Address Fax Number:
413-458-3156
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
413-447-2996

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0022 , 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: 01120218 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00945804 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0930245 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0925691 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com