Healthcare Provider Details

I. General information

NPI: 1629432521
Provider Name (Legal Business Name): BANE BAY PATH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 KINGSTOWN WAY
DUXBURY MA
02332-4647
US

IV. Provider business mailing address

350 GRANITE ST STE 2203
BRAINTREE MA
02184-4963
US

V. Phone/Fax

Practice location:
  • Phone: 781-585-5561
  • Fax: 781-585-1481
Mailing address:
  • Phone: 781-474-2263
  • Fax: 781-878-3986

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: MR. RICHARD C BANE
Title or Position: PRESIDENT
Credential:
Phone: 781-474-2263