MEDICARE: HANNAH B. GRIFFITH SHAW HOME FOR THE AGED, 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	840	MA

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	:	1578557112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANNAH B. GRIFFITH SHAW HOME FOR THE AGED, INC.

Provider Business Mailing Address
First Line	:	299 WAREHAM ST
Second Line	:
City	:	MIDDLEBORO
State	:	MA
Zip	:	02346-2905
Country	:	US
Telephone Number	:	508-947-0332
Fax Number	:	508-923-4652

Provider Business Practice Location Address
First Line	:	299 WAREHAM ST
Second Line	:
City	:	MIDDLEBORO
State	:	MA
Zip	:	02346-2905
Country	:	US
Telephone Number	:	508-947-0332
Fax Number	:	508-923-4652

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. EDWARD FRANCIS HERRMANN
Credential	:
Telephone Number	:	508-947-0332

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	08/22/2020

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