Healthcare Provider Details

I. General information

NPI: 1285750802
Provider Name (Legal Business Name): WESTBROOK HEIGHTS REST HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 E.MAIN STREET
WEST BROOKFIELD MA
01585-0580
US

IV. Provider business mailing address

PO BOX 580
WEST BROOKFIELD MA
01585-0580
US

V. Phone/Fax

Practice location:
  • Phone: 508-867-2062
  • Fax:
Mailing address:
  • Phone: 508-867-2062
  • Fax: 508-867-2925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number1248
License Number StateMA

VIII. Authorized Official

Name: MS. GERMANA A RICHARD
Title or Position: ADMINISTRATOR
Credential: OWNER
Phone: 508-867-2062