Healthcare Provider Details

I. General information

NPI: 1457708695
Provider Name (Legal Business Name): GORDON OPERATING COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 ALDEN RD
FAIRHAVEN MA
02719-4451
US

IV. Provider business mailing address

4 BATTERY WHARF SUITE 4404
BOSTON MA
02109-1099
US

V. Phone/Fax

Practice location:
  • Phone: 508-991-8600
  • Fax: 508-992-3708
Mailing address:
  • Phone: 617-694-1131
  • 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. PETER S GORDON
Title or Position: OWNER
Credential:
Phone: 617-731-7991