Healthcare Provider Details

I. General information

NPI: 1568716314
Provider Name (Legal Business Name): WINSOR SKILLED NURSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 N MAIN ST
SOUTH YARMOUTH MA
02664-2083
US

IV. Provider business mailing address

265 N MAIN ST
SOUTH YARMOUTH MA
02664-2083
US

V. Phone/Fax

Practice location:
  • Phone: 208-394-3514
  • Fax:
Mailing address:
  • Phone: 508-394-3514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number2801
License Number StateMA

VIII. Authorized Official

Name: MS. AMANDA JEAN MAYO
Title or Position: COTA
Credential: COTA/L
Phone: 508-367-2501