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General NPI Number Information
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NPI Number | 1639230584
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Entity Type | Organization
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Legal Business Name | 84 ELM ST., INC.
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 12/16/2011
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Provider Practice Location Address
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Address Line | 84 ELM ST
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City | HOLLISTON
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State | MA
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Zip | 01746-2138
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Country | US
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Telephone | 508-429-4566
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Fax | 508-429-4581
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Provider Business Mailing Address
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Address Line | 80 ACCESS RD
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City | NORWOOD
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State | MA
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Zip | 02062-5237
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Country | US
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Telephone | 781-762-0703
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Fax | 781-762-2099
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Authorized Official
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Title or Position | CONTROLLER
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Name | PETER H. THISSE
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Credential |
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Telephone | 781-762-0703
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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 | 0374
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License Number State | MA
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