=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306833181
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VERNON HALL, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8 DANA ST
-----------------------------------------------------
City | CAMBRIDGE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02138-5402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-864-4267
-----------------------------------------------------
Fax | 671-547-6962
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 DANA ST
-----------------------------------------------------
City | CAMBRIDGE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02138-5402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-864-4267
-----------------------------------------------------
Fax | 671-547-6962
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. MICHELE P CRONIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 617-864-4267
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 0233
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------