Healthcare Provider Details

I. General information

NPI: 1093015935
Provider Name (Legal Business Name): STONEHEDGE MA SNF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 REDLANDS RD
WEST ROXBURY MA
02132-1506
US

IV. Provider business mailing address

135 SOUTH RD
FARMINGTON CT
06032-2556
US

V. Phone/Fax

Practice location:
  • Phone: 617-327-6325
  • Fax: 617-327-8204
Mailing address:
  • Phone: 860-751-3900
  • Fax: 860-751-3905

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. MICHAEL E MOSIER
Title or Position: CFO
Credential:
Phone: 860-751-3900