Healthcare Provider Details

I. General information

NPI: 1518905256
Provider Name (Legal Business Name): MORNINGSIDE OF LEXINGTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 OLD CHAPIN RD
LEXINGTON SC
29072
US

IV. Provider business mailing address

400 CENTRE ST
NEWTON MA
02458
US

V. Phone/Fax

Practice location:
  • Phone: 803-957-3600
  • Fax: 803-359-6187
Mailing address:
  • Phone: 617-796-8387
  • Fax: 617-796-8375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberCRC-1280
License Number StateSC

VIII. Authorized Official

Name: BRUCE J MACKEY JR.
Title or Position: PRESIDENT & CHIEF EXECUTIVE OFFICER
Credential:
Phone: 617-796-8214