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NPI Code Detail

MEDICARE: SENIOR RESIDENTIAL CARE - KINGSTON, INC.

MEDICARE: SENIOR RESIDENTIAL CARE - KINGSTON, INC.
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
1310400000XAssisted Living FacilityMA
2314000000XSkilled Nursing Facility0931MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144279712
Entity Type Code : Organization
Provider Name (Legal Business Name) : SENIOR RESIDENTIAL CARE - KINGSTON, INC.
Provider Business Mailing Address
First Line : 63 KENDRICK ST
Second Line :
City : NEEDHAM
State : MA
Zip : 02494-2708
Country : US
Telephone Number : 781-707-9085
Fax Number : 781-707-9285
Provider Business Practice Location Address
First Line : 17 CHIPMAN WAY
Second Line :
City : KINGSTON
State : MA
Zip : 02364-1039
Country : US
Telephone Number : 781-585-4100
Fax Number : 781-585-1651
Authorized Official
Title or Position : CFO
Name : MS. TAMILYN M. LEVIN
Credential : ESQ.
Telephone Number : 781-707-9510
Provider Enumeration Date : 05/09/2006
Last Update Date : 10/05/2012

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