Healthcare Provider Details

I. General information

NPI: 1831198555
Provider Name (Legal Business Name): 64 PERFORMANCE DRIVE OPERATING COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 PERFORMANCE DR.
WEYMOUTH MA
02189
US

IV. Provider business mailing address

64 PERFORMANCE DR.
WEYMOUTH MA
02189
US

V. Phone/Fax

Practice location:
  • Phone: 781-340-9800
  • Fax: 781-340-1771
Mailing address:
  • Phone: 781-340-9800
  • Fax: 781-340-1771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: EMILY VAZQUEZ
Title or Position: VP, SPECIAL PROJECTS
Credential:
Phone: 978-930-6051