MEDICARE: MORNINGSIDE OF MADISON, 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	10119	AL

General Provider Information

NPI Number	:	1609814201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORNINGSIDE OF MADISON, LLC

Provider Business Mailing Address
First Line	:	400 CENTRE ST
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02458-2094
Country	:	US
Telephone Number	:	617-796-8387
Fax Number	:	617-796-8385

Provider Business Practice Location Address
First Line	:	49 HUGHES RD
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-2238
Country	:	US
Telephone Number	:	256-464-9090
Fax Number	:	256-461-6889

Authorized Official
Title or Position	:	PRESIDENT & CHIEF EXECUTIVE OFFICER
Name	:	BRUCE J MACKEY JR.
Credential	:
Telephone Number	:	617-796-8214

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	06/27/2016

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