Healthcare Provider Details

I. General information

NPI: 1649266214
Provider Name (Legal Business Name): QUABBIN VALLEY CONVALESCENT CENTER,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 DANIEL SHAYS HWY
ATHOL MA
01331-9609
US

IV. Provider business mailing address

821 DANIEL SHAYS HWY
ATHOL MA
01331-9609
US

V. Phone/Fax

Practice location:
  • Phone: 978-249-3717
  • Fax: 978-249-7700
Mailing address:
  • Phone: 978-249-3717
  • Fax: 978-249-7700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0071
License Number StateMA

VIII. Authorized Official

Name: DIANE O'BRIEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 978-249-3717