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General NPI Number Information
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NPI Number | 1003119462
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Entity Type | Organization
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Legal Business Name | LEDGEWOOD BAY RETIREMENT LIVING LLC
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Dates
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Enumeration Date | 12/07/2010
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Last Update Date | 12/07/2010
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Provider Practice Location Address
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Address Line | 43 LEDGEWOOD DR
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City | MILFORD
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State | NH
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Zip | 03055-6736
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Country | US
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Telephone | 603-672-5037
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Fax |
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Provider Business Mailing Address
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Address Line | 1818 LIBRARY ST
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City | RESTON
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State | VA
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Zip | 20190-6242
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Country | US
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Telephone | 416-487-2020
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DOUGLAS MACLATCHY
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Credential |
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Telephone | 416-487-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 03650
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License Number State | NH
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