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General NPI Number Information
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NPI Number | 1003943515
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Entity Type | Organization
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Legal Business Name | MCFADDEN MEMORIAL MANOR
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 08/06/2008
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Provider Practice Location Address
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Address Line | 341 FOREST ST
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City | MALDEN
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State | MA
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Zip | 02148-1604
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Country | US
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Telephone | 781-322-1700
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Fax | 781-397-7375
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Provider Business Mailing Address
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Address Line | 341 FOREST ST
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City | MALDEN
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State | MA
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Zip | 02148-1604
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Country | US
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Telephone | 781-322-1700
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Fax | 781-397-7375
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Authorized Official
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Title or Position | DIRECTOR
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Name | GARY RICHARD DIXON
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Credential |
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Telephone | 781-322-1701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 0686
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License Number State | MA
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