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General NPI Number Information
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NPI Number | 1669846358
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Entity Type | Organization
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Legal Business Name | SRC BREWSTER ALF, LLC
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Dates
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Enumeration Date | 11/19/2015
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Last Update Date | 11/19/2015
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Provider Practice Location Address
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Address Line | 855 HARWICH RD
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City | BREWSTER
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State | MA
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Zip | 02631-5223
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Country | US
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Telephone | 508-896-3252
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Fax |
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Provider Business Mailing Address
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Address Line | 63 KENDRICK ST
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City | NEEDHAM
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State | MA
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Zip | 02494-2708
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | TAMILYN LEVIN
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Credential |
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Telephone | 781-707-9510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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