Healthcare Provider Details

I. General information

NPI: 1881668382
Provider Name (Legal Business Name): COLONIAL NURSING HOME OF WEYMOUTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 BROAD ST
WEYMOUTH MA
02188-2336
US

IV. Provider business mailing address

52 ACCORD PARK DR
NORWELL MA
02061-1628
US

V. Phone/Fax

Practice location:
  • Phone: 781-337-3121
  • Fax: 781-337-7510
Mailing address:
  • Phone: 781-878-6700
  • Fax: 781-878-9807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0442
License Number StateMA

VIII. Authorized Official

Name: MR. MICHAEL WELCH
Title or Position: VICE PRESIDENT
Credential:
Phone: 781-337-3121