Healthcare Provider Details

I. General information

NPI: 1609651488
Provider Name (Legal Business Name): STOUGHTON OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 PARK ST
STOUGHTON MA
02072-3762
US

IV. Provider business mailing address

257 WASHINGTON ST
WESTWOOD MA
02090-1341
US

V. Phone/Fax

Practice location:
  • Phone: 781-344-7300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM SEGAL
Title or Position: OWNER
Credential:
Phone: 917-202-0623