Healthcare Provider Details

I. General information

NPI: 1457357659
Provider Name (Legal Business Name): ELIZABETH SETON RESIDENCE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 OAKLAND ST
WELLESLEY HILLS MA
02481-5338
US

IV. Provider business mailing address

125 OAKLAND ST
WELLESLEY HILLS MA
02481-5338
US

V. Phone/Fax

Practice location:
  • Phone: 781-237-2161
  • Fax: 781-431-2589
Mailing address:
  • Phone: 781-237-2161
  • Fax: 781-431-2589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number854
License Number StateMA

VIII. Authorized Official

Name: MRS. LORI FERRANTE
Title or Position: ADMINISTRATOR
Credential:
Phone: 781-997-1130