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General NPI Number Information
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NPI Number | 1700421948
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Entity Type | Organization
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Legal Business Name | SRC PITTSFIELD OP, LLC
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Dates
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Enumeration Date | 11/12/2019
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Last Update Date | 11/12/2019
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Provider Practice Location Address
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Address Line | 140 MELBOURNE RD
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City | PITTSFIELD
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State | MA
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Zip | 01201-8533
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Country | US
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Telephone | 413-499-1992
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Fax | 413-443-8870
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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 | 02494-2760
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Country | US
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Telephone | 781-707-9085
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Fax | 781-281-8827
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Authorized Official
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Title or Position | GENERAL COUNSEL
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Name | JONATHAN SCHARF
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Credential |
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Telephone | 781-707-9030
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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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