Healthcare Provider Details

I. General information

NPI: 1023588696
Provider Name (Legal Business Name): EMANUEL DEVELOPMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BELLAMY ST
BRIGHTON MA
02135
US

IV. Provider business mailing address

14 EAST WORCESTER STREET SUITE 300
WORCESTER MA
01604
US

V. Phone/Fax

Practice location:
  • Phone: 617-782-8113
  • Fax:
Mailing address:
  • Phone: 774-243-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ALDEN
Title or Position: VP OF BUSINESS DEVELOPMENT
Credential:
Phone: 508-340-9628