Healthcare Provider Details

I. General information

NPI: 1720994932
Provider Name (Legal Business Name): CENTERVILLE SNF OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S MAIN ST
CENTERVILLE MA
02632-3246
US

IV. Provider business mailing address

10913 S RIVER FRONT PKWY STE 290
SOUTH JORDAN UT
84095-3563
US

V. Phone/Fax

Practice location:
  • Phone: 508-778-1835
  • Fax:
Mailing address:
  • Phone: 508-778-1835
  • 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: BRIAN RAMOS
Title or Position: MANAGER
Credential:
Phone: 508-771-3320