MEDICARE: BEAUMONT AT THE WILLOWS

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	0865	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	:	1538156773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUMONT AT THE WILLOWS

Provider Business Mailing Address
First Line	:	3 LYMAN ST
Second Line	:
City	:	WESTBOROUGH
State	:	MA
Zip	:	01581-1442
Country	:	US
Telephone Number	:	508-898-3490
Fax Number	:	508-898-1805

Provider Business Practice Location Address
First Line	:	3 LYMAN ST
Second Line	:
City	:	WESTBOROUGH
State	:	MA
Zip	:	01581-1442
Country	:	US
Telephone Number	:	508-898-3490
Fax Number	:	508-898-1805

Authorized Official
Title or Position	:	CFO
Name	:	MR. GARY SACON
Credential	:
Telephone Number	:	508-898-3490

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	03/13/2012

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Directions to “BEAUMONT AT THE WILLOWS ” Practice Location

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