Healthcare Provider Details

I. General information

NPI: 1639117310
Provider Name (Legal Business Name): PARKWELL HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 TRUMAN HWY
HYDE PARK MA
02136-3536
US

IV. Provider business mailing address

745 TRUMAN HWY
HYDE PARK MA
02136-3536
US

V. Phone/Fax

Practice location:
  • Phone: 617-361-8300
  • Fax: 617-361-7725
Mailing address:
  • Phone: 617-361-8300
  • Fax: 617-361-7725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0516
License Number StateMA

VII. Legacy identifiers

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

# 1
Identifier0940534
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 2
Identifier110026654B
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: PAULA J. TOPJIAN
Title or Position: MANAGER
Credential:
Phone: 617-361-8300