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General NPI Number Information
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NPI Number | 1508852757
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Entity Type | Organization
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Legal Business Name | WACHUSETT EXTENDED CARE FACILITY INC
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Dates
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Enumeration Date | 09/23/2005
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Last Update Date | 04/17/2013
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Provider Practice Location Address
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Address Line | 56 BOYDEN ROAD
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City | HOLDEN
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State | MA
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Zip | 01520-2570
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Country | US
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Telephone | 508-829-1104
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Fax | 508-829-1221
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Provider Business Mailing Address
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Address Line | 54 BOYDEN ROAD
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City | HOLDEN
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State | MA
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Zip | 01520-2570
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Country | US
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Telephone | 508-829-1110
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Fax | 508-829-1234
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. SANDRA MAHONEY
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Credential |
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Telephone | 508-829-1104
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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 | 0930172
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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