Healthcare Provider Details

I. General information

NPI: 1124014469
Provider Name (Legal Business Name): NEEDHAM REHABILITATION & NURSING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 06/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 LINCOLN ST
NEEDHAM MA
02492-2914
US

IV. Provider business mailing address

150 LINCOLN ST
NEEDHAM MA
02492-2914
US

V. Phone/Fax

Practice location:
  • Phone: 781-449-4040
  • Fax: 781-449-4129
Mailing address:
  • Phone: 781-449-4040
  • Fax: 781-449-4129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0784
License Number StateMA

VII. Legacy identifiers

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

# 1
Identifier0929263
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: MR. WALTER M COLLINS
Title or Position: ADMINISTRATOR
Credential:
Phone: 781-449-4040