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General NPI Number Information
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NPI Number | 1164477055
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Entity Type | Organization
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Legal Business Name | 4499 ACUSHNET AVENUE OPERATING COMPANY, LLC
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 12/08/2017
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Provider Practice Location Address
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Address Line | 4499 ACUSHNET AVE
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City | NEW BEDFORD
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State | MA
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Zip | 02745-4707
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Country | US
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Telephone | 508-995-6900
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Fax | 508-985-9615
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Provider Business Mailing Address
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Address Line | 4499 ACUSHNET AVENUE
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City | NEW BEDFORD
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State | MA
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Zip | 02745-4707
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Country | US
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Telephone | 508-995-6900
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Fax | 508-998-5974
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BRAD E. HOLLINGER
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Credential |
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Telephone | 717-591-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282E00000X
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Taxonomy Name | Long Term Care Hospital
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License Number | 079
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License Number State | MA
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