Healthcare Provider Details

I. General information

NPI: 1073509378
Provider Name (Legal Business Name): METRO HEALTH FOUNDATION OF MASSACHUSETTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 ALDEN ROAD
FAIRHAVEN MA
02719-4451
US

IV. Provider business mailing address

389 ALDEN ROAD
FAIRHAVEN MA
02719-4451
US

V. Phone/Fax

Practice location:
  • Phone: 508-991-8600
  • Fax: 508-992-3708
Mailing address:
  • Phone: 508-991-8600
  • Fax: 508-992-3708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0912
License Number StateMA

VIII. Authorized Official

Name: MR. RONALD BRIDGE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 508-717-0102