Healthcare Provider Details

I. General information

NPI: 1811120413
Provider Name (Legal Business Name): SARAH BRAYTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2009
Last Update Date: 08/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 N MAIN ST
FALL RIVER MA
02720-2080
US

IV. Provider business mailing address

4901 N MAIN ST
FALL RIVER MA
02720-2080
US

V. Phone/Fax

Practice location:
  • Phone: 508-675-1001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number00994
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number7505
License Number StateMA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: CHERYL GRECO
Title or Position: REHAB MANAGER
Credential: PTA
Phone: 508-675-1001