Healthcare Provider Details

I. General information

NPI: 1790119212
Provider Name (Legal Business Name): ALLIANCE HEALTH OF WRENTHAM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 TAUNTON ST
WRENTHAM MA
02093-1349
US

IV. Provider business mailing address

90 TAUNTON ST
WRENTHAM MA
02093-1349
US

V. Phone/Fax

Practice location:
  • Phone: 508-384-7977
  • Fax: 508-384-3208
Mailing address:
  • Phone: 508-384-7977
  • Fax: 508-384-3208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number225476
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: PAUL KEMP
Title or Position: TREASURER AND CFO
Credential:
Phone: 774-348-2001