Healthcare Provider Details

I. General information

NPI: 1104376284
Provider Name (Legal Business Name): REDWOOD ACQUISITION EAST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 WASHINGTON ST
GLOUCESTER MA
01930-4818
US

IV. Provider business mailing address

272 WASHINGTON ST
GLOUCESTER MA
01930-4818
US

V. Phone/Fax

Practice location:
  • Phone: 978-281-0333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: JAMES MAMARY
Title or Position: PRESIDENT
Credential:
Phone: 781-826-2393