Healthcare Provider Details

I. General information

NPI: 1902983240
Provider Name (Legal Business Name): SEACOAST NURSING AND REHABILITATION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 05/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 WASHINGTON ST
GLOUCESTER MA
01930-4832
US

IV. Provider business mailing address

292 WASHINGTON ST
GLOUCESTER MA
01930-4832
US

V. Phone/Fax

Practice location:
  • Phone: 978-283-0300
  • Fax: 978-281-6774
Mailing address:
  • Phone: 978-283-0300
  • Fax: 978-281-6774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0946
License Number StateMA

VIII. Authorized Official

Name: MS. MARILYN WEAVER
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 502-596-7563