Healthcare Provider Details

I. General information

NPI: 1326109141
Provider Name (Legal Business Name): 137 NICHOLS ST., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 12/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 NICHOLS ST
NORWOOD MA
02062-2009
US

IV. Provider business mailing address

80 ACCESS RD
NORWOOD MA
02062-5237
US

V. Phone/Fax

Practice location:
  • Phone: 781-762-0858
  • Fax: 761-762-4114
Mailing address:
  • Phone: 781-762-0703
  • Fax: 781-762-2099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0407
License Number StateMA

VIII. Authorized Official

Name: PETER H THISSE
Title or Position: CONTROLLER
Credential:
Phone: 781-762-0703