Healthcare Provider Details

I. General information

NPI: 1013475722
Provider Name (Legal Business Name): BEAR MT FALL RIVER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 OAK GROVE AVE
FALL RIVER MA
02723-2315
US

IV. Provider business mailing address

130 S MAIN ST STE 203
THOMASTON CT
06787-1741
US

V. Phone/Fax

Practice location:
  • Phone: 508-679-4866
  • Fax:
Mailing address:
  • Phone: 860-880-8202
  • Fax: 860-880-8205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: THOMAS H DOYLE II
Title or Position: MEMBER/COO
Credential:
Phone: 860-880-8202