MEDICARE: LONG TERM CENTERS OF WRENTHAM, INC

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	314000000X	Skilled Nursing Facility		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	:	1063419521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONG TERM CENTERS OF WRENTHAM, INC

Provider Business Mailing Address
First Line	:	655 DEDHAM ST
Second Line	:
City	:	WRENTHAM
State	:	MA
Zip	:	02093-1135
Country	:	US
Telephone Number	:	508-384-3400
Fax Number	:	508-384-8005

Provider Business Practice Location Address
First Line	:	655 DEDHAM ST
Second Line	:
City	:	WRENTHAM
State	:	MA
Zip	:	02093-1135
Country	:	US
Telephone Number	:	508-384-3400
Fax Number	:	508-384-8005

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MR. MATTHEW J SWEENEY JR.
Credential	:	M.S., N.H.A.
Telephone Number	:	508-384-3400

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	07/21/2022

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