MEDICARE: MILL POND ASSISTED CARE LLC

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1063239069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILL POND ASSISTED CARE LLC

Provider Business Mailing Address
First Line	:	38 WELCH RD
Second Line	:
City	:	BROOKLINE
State	:	MA
Zip	:	02445-7526
Country	:	US
Telephone Number	:	617-319-2914
Fax Number	:

Provider Business Practice Location Address
First Line	:	84 MYRTLE ST
Second Line	:
City	:	ASHLAND
State	:	MA
Zip	:	01721-1113
Country	:	US
Telephone Number	:	617-319-2914
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	JAMSHED KHAN
Credential	:
Telephone Number	:	617-319-2914

Provider Enumeration Date	:	09/23/2024
Last Update Date	:	09/23/2024

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