1710359161 NPI number — BSL- BN COMMONS SNF OPERATOR LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710359161 NPI number — BSL- BN COMMONS SNF OPERATOR LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BSL- BN COMMONS SNF OPERATOR LLC
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:
Provider Other Organization Name Type Code:
6
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:
1710359161
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 JONES RD
Provider Second Line Business Mailing Address:
SUITE 300 WEST
Provider Business Mailing Address City Name:
WALTHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02451-1600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-489-7100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 HARVEST CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01773-3214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-430-6000
Provider Business Practice Location Address Fax Number:
781-439-6008
Provider Enumeration Date:
10/26/2015

Additional Information

Authorized Official

Authorized Official Last Name:
GRAPE
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRINCIPAL/LLC MANAGER
Authorized Official Telephone Number:
781-489-7100

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , 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)





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