MEDICARE: 8 BUTLER ST., 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	0145	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0692820001	OTHER	MA	MEDICARE NSC

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	:	1164583589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	8 BUTLER ST., INC.

Provider Business Mailing Address
First Line	:	80 ACCESS RD
Second Line	:
City	:	NORWOOD
State	:	MA
Zip	:	02062-5237
Country	:	US
Telephone Number	:	781-762-0703
Fax Number	:	781-762-2099

Provider Business Practice Location Address
First Line	:	8 BUTLER ST
Second Line	:
City	:	BLACKSTONE
State	:	MA
Zip	:	01504-1541
Country	:	US
Telephone Number	:	508-883-5818
Fax Number	:	508-883-5819

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MR. PETER H. THISSE
Credential	:
Telephone Number	:	781-762-0703

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	12/16/2011

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Directions to “8 BUTLER ST., INC. ” Practice Location

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