Healthcare Provider Details

I. General information

NPI: 1902565062
Provider Name (Legal Business Name): WATERTOWN REHABILITATION AND NURSING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 COOLIDGE HILL RD
WATERTOWN MA
02472-2816
US

IV. Provider business mailing address

59 COOLIDGE HILL RD
WATERTOWN MA
02472-2816
US

V. Phone/Fax

Practice location:
  • Phone: 617-924-1130
  • Fax:
Mailing address:
  • Phone: 617-924-1130
  • 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: AKIVA HOROWITZ
Title or Position: MANAGER
Credential:
Phone: 617-924-1130