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General NPI Number Information
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NPI Number | 1144223074
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Entity Type | Organization
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Legal Business Name | MEDWAY COUNTRY MANOR, INC.
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 07/30/2014
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Provider Practice Location Address
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Address Line | 115 HOLLISTON ST
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City | MEDWAY
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State | MA
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Zip | 02053-1954
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Country | US
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Telephone | 508-533-6634
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Fax | 508-533-7048
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Provider Business Mailing Address
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Address Line | 115 HOLLISTON ST
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City | MEDWAY
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State | MA
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Zip | 02053-1954
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Country | US
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Telephone | 508-533-6634
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Fax | 508-533-7048
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAVID SIMHA
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Credential |
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Telephone | 917-885-7050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 0840
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0840
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 0840
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 0840
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License Number State | MA
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