Healthcare Provider Details

I. General information

NPI: 1801957246
Provider Name (Legal Business Name): COREY HILL NURSING HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 12/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 COREY RD
BRIGHTON MA
02135-8323
US

IV. Provider business mailing address

80 ACCESS RD
NORWOOD MA
02062-5237
US

V. Phone/Fax

Practice location:
  • Phone: 671-734-7138
  • Fax: 671-731-8359
Mailing address:
  • Phone: 781-762-0703
  • Fax: 781-762-2099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0528
License Number StateMA

VIII. Authorized Official

Name: MR. PETER H. THISSE
Title or Position: CONTROLLER
Credential:
Phone: 781-762-0703