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General NPI Number Information
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NPI Number | 1457708695
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Entity Type | Organization
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Legal Business Name | GORDON OPERATING COMPANY LLC
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Dates
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Enumeration Date | 05/18/2016
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 389 ALDEN RD
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City | FAIRHAVEN
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State | MA
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Zip | 02719-4451
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Country | US
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Telephone | 508-991-8600
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Fax | 508-992-3708
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Provider Business Mailing Address
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Address Line | 4 BATTERY WHARF SUITE 4404
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City | BOSTON
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State | MA
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Zip | 02109-1099
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Country | US
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Telephone | 617-694-1131
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Fax | 508-992-3708
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Authorized Official
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Title or Position | OWNER
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Name | MR. PETER S GORDON
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Credential |
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Telephone | 617-731-7991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 0912
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License Number State | MA
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