Healthcare Provider Details

I. General information

NPI: 1700909249
Provider Name (Legal Business Name): HATHAWAY MANOR NURSING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

863 HATHAWAY RD
NEW BEDFORD MA
02740-1916
US

IV. Provider business mailing address

75 NORTH ST STE 210
PITTSFIELD MA
01201-5126
US

V. Phone/Fax

Practice location:
  • Phone: 508-996-6763
  • Fax: 508-996-8596
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0902
License Number StateMA

VIII. Authorized Official

Name: WILLIAM C JONES
Title or Position: PRESIDENT
Credential:
Phone: 413-447-2996