Healthcare Provider Details

I. General information

NPI: 1588740153
Provider Name (Legal Business Name): ROSCOMMON HEALTHCARE WEST ROXBURY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 WASHINGTON ST
WEST ROXBURY MA
02132-4738
US

IV. Provider business mailing address

5060 WASHINGTON ST
WEST ROXBURY MA
02132-4738
US

V. Phone/Fax

Practice location:
  • Phone: 617-323-5440
  • Fax: 617-469-5543
Mailing address:
  • Phone: 617-323-5440
  • Fax: 617-469-5543

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. JOHN P BURKE
Title or Position: CFO/OWNER
Credential: CPA
Phone: 617-325-1688