MEDICARE: WOBURN NURSING CENTER, 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	4213	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	803059	OTHER	MA	TUFTS/SECURE HORIZON
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	903183	OTHER	MA	HARVARD PILGRIM HEALTH
4	2222539401	OTHER	MA	BLUE CROSS BLUE SHIELD
5	552468	OTHER	MA	AETNA/ US HEALTHCARE

General Provider Information

NPI Number	:	1285638890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOBURN NURSING CENTER, INC

Provider Business Mailing Address
First Line	:	18 FRANCES ST
Second Line	:
City	:	WOBURN
State	:	MA
Zip	:	01801-3006
Country	:	US
Telephone Number	:	781-933-8175
Fax Number	:	781-729-3817

Provider Business Practice Location Address
First Line	:	18 FRANCES ST
Second Line	:
City	:	WOBURN
State	:	MA
Zip	:	01801-3006
Country	:	US
Telephone Number	:	781-933-8175
Fax Number	:	781-729-3817

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MR. ROBERT DRISCOLL
Credential	:
Telephone Number	:	781-994-2114

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	08/22/2020

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