MEDICARE: LAFAYETTE CONVALESCENT HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	0291	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003803107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAFAYETTE CONVALESCENT HOME

Provider Business Mailing Address
First Line	:	25 LAFAYETTE ST
Second Line	:
City	:	MARBLEHEAD
State	:	MA
Zip	:	01945-1939
Country	:	US
Telephone Number	:	781-631-4535
Fax Number	:	781-631-6400

Provider Business Practice Location Address
First Line	:	25 LAFAYETTE ST
Second Line	:
City	:	MARBLEHEAD
State	:	MA
Zip	:	01945-1939
Country	:	US
Telephone Number	:	781-631-4535
Fax Number	:	781-631-6400

Authorized Official
Title or Position	:	CORPORATE BILLING MANAGER
Name	:	MS. LAURA MCDONNELL
Credential	:
Telephone Number	:	978-420-1500

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	08/22/2020

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Directions to “LAFAYETTE CONVALESCENT HOME ” Practice Location

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