Healthcare Provider Details

I. General information

NPI: 1700118957
Provider Name (Legal Business Name): STERLING VILLAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2010
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 DANA HILL RD
STERLING MA
01564-2414
US

IV. Provider business mailing address

18 DANA HILL RD
STERLING MA
01564-2414
US

V. Phone/Fax

Practice location:
  • Phone: 978-422-5111
  • Fax: 978-422-5925
Mailing address:
  • Phone: 978-422-5111
  • Fax: 978-422-5925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0082
License Number StateMA

VIII. Authorized Official

Name: MR. SEAN E D'URSO
Title or Position: CFO
Credential:
Phone: 617-332-8481