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NPI Code Detail

MEDICARE: BANE HANCOCK PARK, LLC

MEDICARE: BANE HANCOCK PARK, 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
1310400000XAssisted Living Facility

General Provider Information

NPI Number : 1306293642
Entity Type Code : Organization
Provider Name (Legal Business Name) : BANE HANCOCK PARK, LLC
Provider Business Mailing Address
First Line : 350 GRANITE ST STE 2304
Second Line :
City : BRAINTREE
State : MA
Zip : 02184-4963
Country : US
Telephone Number : 781-474-2263
Fax Number :
Provider Business Practice Location Address
First Line : 164 PARKINGWAY
Second Line :
City : QUINCY
State : MA
Zip : 02169-5020
Country : US
Telephone Number : 617-773-4222
Fax Number : 617-773-1115
Authorized Official
Title or Position : DIRECTOR OF REVENUE CYCLE MANAGEMEN
Name : PAMELA PENNELL
Credential :
Telephone Number : 603-923-9437
Provider Enumeration Date : 05/17/2016
Last Update Date : 08/25/2025

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