Healthcare Provider Details

I. General information

NPI: 1609225721
Provider Name (Legal Business Name): ROYAL WAYLAND NURSING HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 03/30/2020
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 COMMONWEALTH RD
WAYLAND MA
01778-5027
US

IV. Provider business mailing address

42 WINTER ST STE 1
PEMBROKE MA
02359-4958
US

V. Phone/Fax

Practice location:
  • Phone: 508-653-8500
  • Fax:
Mailing address:
  • Phone: 781-826-2393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MS. PAULA REID
Title or Position: CONTROLLER
Credential:
Phone: 774-763-2700