MEDICARE: B-X NORTH ANDOVER 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
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1366959512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	B-X NORTH ANDOVER LLC

Provider Business Mailing Address
First Line	:	700 CHICKERING RD
Second Line	:
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-1928
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 CHICKERING RD
Second Line	:
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-1928
Country	:	US
Telephone Number	:	978-683-1300
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	THOMAS GRAPE
Credential	:
Telephone Number	:	781-489-7100

Provider Enumeration Date	:	01/09/2018
Last Update Date	:	01/09/2018

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Directions to “B-X NORTH ANDOVER LLC ” Practice Location

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