Healthcare Provider Details

I. General information

NPI: 1932195625
Provider Name (Legal Business Name): MEDFORD HEALTH GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 08/22/2020
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

5 REDLANDS RD
WEST ROXBURY MA
02132-1506
US

V. Phone/Fax

Practice location:
  • Phone: 617-327-6325
  • Fax: 617-327-8204
Mailing address:
  • Phone: 617-327-6325
  • Fax: 617-327-8204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0534
License Number StateMA

VIII. Authorized Official

Name: MR. CHRISTOPHER SHEEHAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 671-327-6325