Healthcare Provider Details

I. General information

NPI: 1346236908
Provider Name (Legal Business Name): GERIATRIC AUTHORITY OF MILFORD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COUNTRYSIDE DR
MILFORD MA
01757-1252
US

IV. Provider business mailing address

1 COUNTRYSIDE DR
MILFORD MA
01757-1252
US

V. Phone/Fax

Practice location:
  • Phone: 508-473-0435
  • Fax: 508-473-9755
Mailing address:
  • Phone: 508-473-0435
  • Fax: 508-473-9755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number883
License Number StateMA

VIII. Authorized Official

Name: HEATHER LABRIE
Title or Position: ADMINISTRATOR
Credential:
Phone: 508-473-0435