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NPI Code Detail

MEDICARE: WACHUSETT EXTENDED CARE FACILITY INC

MEDICARE: WACHUSETT EXTENDED CARE FACILITY 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
1313M00000XNursing Facility/Intermediate Care Facility0930172MA
2314000000XSkilled Nursing Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508852757
Entity Type Code : Organization
Provider Name (Legal Business Name) : WACHUSETT EXTENDED CARE FACILITY INC
Provider Business Mailing Address
First Line : 54 BOYDEN ROAD
Second Line :
City : HOLDEN
State : MA
Zip : 01520-2570
Country : US
Telephone Number : 508-829-1110
Fax Number : 508-829-1234
Provider Business Practice Location Address
First Line : 56 BOYDEN ROAD
Second Line :
City : HOLDEN
State : MA
Zip : 01520-2570
Country : US
Telephone Number : 508-829-1104
Fax Number : 508-829-1221
Authorized Official
Title or Position : ADMINISTRATOR
Name : MS. SANDRA MAHONEY
Credential :
Telephone Number : 508-829-1104
Provider Enumeration Date : 09/23/2005
Last Update Date : 04/17/2013

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Directions to “WACHUSETT EXTENDED CARE FACILITY INC ” Practice Location

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