Healthcare Provider Details

I. General information

NPI: 1386193845
Provider Name (Legal Business Name): WACHUSETT HEALTHCARE MANAGEMENT COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 WASHINGTON ST SUITE 190
WELLESLEY HILLS MA
02481-1900
US

IV. Provider business mailing address

36 WASHINGTON ST SUITE 190
WELLESLEY HILLS MA
02481-1900
US

V. Phone/Fax

Practice location:
  • Phone: 781-943-3104
  • Fax:
Mailing address:
  • Phone: 781-943-3104
  • 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: MR. RAYMOND A. DENNEHY III
Title or Position: PRINCIPAL
Credential:
Phone: 978-886-3336