Healthcare Provider Details

I. General information

NPI: 1306293642
Provider Name (Legal Business Name): BANE HANCOCK PARK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 PARKINGWAY
QUINCY MA
02169-5020
US

IV. Provider business mailing address

350 GRANITE ST STE 2304
BRAINTREE MA
02184-4963
US

V. Phone/Fax

Practice location:
  • Phone: 617-773-4222
  • Fax: 617-773-1115
Mailing address:
  • Phone: 781-474-2263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: PAMELA PENNELL
Title or Position: DIRECTOR OF REVENUE CYCLE MANAGEMEN
Credential:
Phone: 603-923-9437