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General NPI Number Information
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NPI Number | 1992784037
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Entity Type | Organization
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Legal Business Name | AGAWAM NURSING LLC
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Dates
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Enumeration Date | 01/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1200 SUFFIELD ST
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City | AGAWAM
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State | MA
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Zip | 01001-2933
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Country | US
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Telephone | 413-789-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 50 KERRY PL
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City | NORWOOD
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State | MA
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Zip | 02062-4775
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Country | US
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Telephone | 781-619-0250
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. BRAD ROLPH
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Credential |
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Telephone | 781-297-8626
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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 | 0967
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License Number State | MA
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