Healthcare Provider Details

I. General information

NPI: 1306833181
Provider Name (Legal Business Name): VERNON HALL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 DANA ST
CAMBRIDGE MA
02138-5402
US

IV. Provider business mailing address

8 DANA ST
CAMBRIDGE MA
02138-5402
US

V. Phone/Fax

Practice location:
  • Phone: 617-864-4267
  • Fax: 671-547-6962
Mailing address:
  • Phone: 617-864-4267
  • Fax: 671-547-6962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0233
License Number StateMA

VIII. Authorized Official

Name: MRS. MICHELE P CRONIN
Title or Position: OWNER
Credential:
Phone: 617-864-4267