Healthcare Provider Details

I. General information

NPI: 1851374409
Provider Name (Legal Business Name): LASELL VILLAGE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SEMINARY AVE
AUBURNDALE MA
02466-2650
US

IV. Provider business mailing address

120 SEMINARY AVE
AUBURNDALE MA
02466-2650
US

V. Phone/Fax

Practice location:
  • Phone: 617-663-7000
  • Fax: 617-663-7001
Mailing address:
  • Phone: 617-663-7000
  • Fax: 617-663-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHARI MEGA
Title or Position: DIRECTOR OF BUSINESS & FINANCE
Credential:
Phone: 617-663-7056