Healthcare Provider Details

I. General information

NPI: 1922097633
Provider Name (Legal Business Name): WESTERN MASSACHUSETTS LIFECARE CORPORATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 WILBRAHAM RD
SPRINGFIELD MA
01109-2067
US

IV. Provider business mailing address

807 WILBRAHAM RD
SPRINGFIELD MA
01109-2067
US

V. Phone/Fax

Practice location:
  • Phone: 413-782-1800
  • Fax: 413-782-8038
Mailing address:
  • Phone: 413-782-1800
  • Fax: 413-782-8038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0990
License Number StateMA

VII. Legacy identifiers

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

# 1
Identifier0922315
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: MS. REBECCA ANN WINTERS
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 413-782-1800