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NPI Code Detail

MEDICARE: 750 WOBURN STREET OPERATING COMPANY, LLC

MEDICARE: 750 WOBURN STREET OPERATING COMPANY, 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
1314000000XSkilled Nursing Facility0911MA

Other Identifiers

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

General Provider Information

NPI Number : 1144229873
Entity Type Code : Organization
Provider Name (Legal Business Name) : 750 WOBURN STREET OPERATING COMPANY, LLC
Provider Business Mailing Address
First Line : 750 WOBURN STREET
Second Line :
City : WILMINGTON
State : MA
Zip : 01887
Country : US
Telephone Number : 978-988-0888
Fax Number : 978-658-6470
Provider Business Practice Location Address
First Line : 750 WOBURN STREET
Second Line :
City : WILMINGTON
State : MA
Zip : 01887
Country : US
Telephone Number : 978-988-0888
Fax Number : 978-658-6470
Authorized Official
Title or Position : VP, SPECIAL PROJECTS
Name : EMILY VAZQUEZ
Credential :
Telephone Number : 978-930-6051
Provider Enumeration Date : 07/15/2005
Last Update Date : 12/15/2023

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Directions to “750 WOBURN STREET OPERATING COMPANY, LLC ” Practice Location

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