MEDICARE: MCFADDEN MEMORIAL MANOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	313M00000X	Nursing Facility/Intermediate Care Facility	0686	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003943515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCFADDEN MEMORIAL MANOR

Provider Business Mailing Address
First Line	:	341 FOREST ST
Second Line	:
City	:	MALDEN
State	:	MA
Zip	:	02148-1604
Country	:	US
Telephone Number	:	781-322-1700
Fax Number	:	781-397-7375

Provider Business Practice Location Address
First Line	:	341 FOREST ST
Second Line	:
City	:	MALDEN
State	:	MA
Zip	:	02148-1604
Country	:	US
Telephone Number	:	781-322-1700
Fax Number	:	781-397-7375

Authorized Official
Title or Position	:	DIRECTOR
Name	:	GARY RICHARD DIXON
Credential	:
Telephone Number	:	781-322-1701

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	08/06/2008

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1194713123 — MCFADDEN MEMORIAL MANOR
Practice Location Address:

341 FOREST ST
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Practice Phone: 781-322-1700
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Practice Location Address:

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1386631604 — DR. ROBERT P. MORO D.C.
Practice Location Address:

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1154310076 — DR. PATRICIA ANN SERENO MD
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1811986292 — ANDREA E GORDON MD
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Practice Fax:

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