1962841031 NPI number — WG LONGMEADOW PLACE SH, 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 1962841031 NPI number — WG LONGMEADOW PLACE SH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WG LONGMEADOW PLACE SH, 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:
1962841031
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 S 4TH ST
Provider Second Line Business Mailing Address:
SUITE 1900, ATTN: LEGAL DEPT.
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40202-3426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-779-4700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42 MALL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01803-4568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-270-9008
Provider Business Practice Location Address Fax Number:
781-270-9009
Provider Enumeration Date:
06/21/2013

Additional Information

Authorized Official

Authorized Official Last Name:
HUDSON
Authorized Official First Name:
W.
Authorized Official Middle Name:
BRYAN
Authorized Official Title or Position:
AUTHORIZED REPRESENTATIVE
Authorized Official Telephone Number:
502-779-4700

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , 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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