Healthcare Provider Details

I. General information

NPI: 1538156773
Provider Name (Legal Business Name): BEAUMONT AT THE WILLOWS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 LYMAN ST
WESTBOROUGH MA
01581-1442
US

IV. Provider business mailing address

3 LYMAN ST
WESTBOROUGH MA
01581-1442
US

V. Phone/Fax

Practice location:
  • Phone: 508-898-3490
  • Fax: 508-898-1805
Mailing address:
  • Phone: 508-898-3490
  • Fax: 508-898-1805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0865
License Number StateMA

VIII. Authorized Official

Name: MR. GARY SACON
Title or Position: CFO
Credential:
Phone: 508-898-3490