Healthcare Provider Details

I. General information

NPI: 1144279712
Provider Name (Legal Business Name): SENIOR RESIDENTIAL CARE - KINGSTON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 CHIPMAN WAY
KINGSTON MA
02364-1039
US

IV. Provider business mailing address

63 KENDRICK ST
NEEDHAM MA
02494-2708
US

V. Phone/Fax

Practice location:
  • Phone: 781-585-4100
  • Fax: 781-585-1651
Mailing address:
  • Phone: 781-707-9085
  • Fax: 781-707-9285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0931
License Number StateMA

VIII. Authorized Official

Name: MS. TAMILYN M. LEVIN
Title or Position: CFO
Credential: ESQ.
Phone: 781-707-9510