Healthcare Provider Details

I. General information

NPI: 1366591919
Provider Name (Legal Business Name): SALEM COMMUNITY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 BRIARWOOD CIR
WORCESTER MA
01606-1225
US

IV. Provider business mailing address

87 BRIARWOOD CIR
WORCESTER MA
01606-1225
US

V. Phone/Fax

Practice location:
  • Phone: 508-853-6910
  • Fax: 508-856-0112
Mailing address:
  • Phone: 508-853-6910
  • Fax: 508-856-0112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0119
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0920096
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: JANICE F WILSON
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 508-852-2670