Healthcare Provider Details

I. General information

NPI: 1487628798
Provider Name (Legal Business Name): DUXBURY HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 KINGSTOWN WAY
DUXBURY MA
02332
US

IV. Provider business mailing address

52 ACCORD PARK DRIVE
NORWELL MA
02061
US

V. Phone/Fax

Practice location:
  • Phone: 781-585-2397
  • Fax: 781-582-2057
Mailing address:
  • Phone: 781-878-6700
  • Fax: 781-878-9807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number0597
License Number StateMA

VIII. Authorized Official

Name: MR. PAUL T. CASOLE
Title or Position: VICE PRESIDENT
Credential:
Phone: 781-878-6700