Healthcare Provider Details

I. General information

NPI: 1851702732
Provider Name (Legal Business Name): PARSONS HILL MA SNF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 MAIN ST
WORCESTER MA
01603-1550
US

IV. Provider business mailing address

1350 MAIN ST
WORCESTER MA
01603-1550
US

V. Phone/Fax

Practice location:
  • Phone: 508-791-4200
  • Fax: 508-791-0269
Mailing address:
  • Phone: 508-791-4200
  • Fax: 508-791-0269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0108
License Number StateMA

VII. Legacy identifiers

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

# 1
Identifier110100227A
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: LAWRENCE G. SANTILLI
Title or Position: MANAGER
Credential:
Phone: 860-751-3900