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General NPI Number Information
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NPI Number | 1609905512
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Entity Type | Organization
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Legal Business Name | LARCHWOOD LODGE NURSING HOME
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 325 BACON ST 325 BACON STREET
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City | WALTHAM
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State | MA
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Zip | 02451-7519
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Country | US
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Telephone | 781-894-5264
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Fax | 781-894-6011
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Provider Business Mailing Address
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Address Line | 96 HILLSIDE AVE 96 HILLSIDE AVE
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City | NEEDHAM
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State | MA
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Zip | 02494-1710
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Country | US
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Telephone | 781-894-5264
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Fax | 781-894-6011
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JAN GALATIS
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Credential |
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Telephone | 781-894-5264
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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 | 0214
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License Number State | MA
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Legacy Identifiers
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Identifier #1
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Identifier Code | 0921947
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Identifier Type | MEDICAID
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Identifier State | MA
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Identifier Issuer |
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 0921947
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Identifier Type | MEDICAID
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Identifier State | MA
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Identifier Issuer |
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