MEDICARE: ROYAL WAYLAND NURSING HOME 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	314000000X	Skilled Nursing Facility		MA

General Provider Information

NPI Number	:	1609225721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYAL WAYLAND NURSING HOME LLC

Provider Business Mailing Address
First Line	:	42 WINTER ST STE 1
Second Line	:
City	:	PEMBROKE
State	:	MA
Zip	:	02359-4958
Country	:	US
Telephone Number	:	781-826-2393
Fax Number	:

Provider Business Practice Location Address
First Line	:	188 COMMONWEALTH RD
Second Line	:
City	:	WAYLAND
State	:	MA
Zip	:	01778-5027
Country	:	US
Telephone Number	:	508-653-8500
Fax Number	:

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MS. PAULA REID
Credential	:
Telephone Number	:	774-763-2700

Provider Enumeration Date	:	06/09/2016
Last Update Date	:	03/30/2020

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