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NPI Code Detail

MEDICARE: SOUTHEAST MA SNF LLC

MEDICARE: SOUTHEAST MA SNF 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
1314000000XSkilled 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

General Provider Information

NPI Number : 1619277050
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHEAST MA SNF LLC
Provider Business Mailing Address
First Line : 135 SOUTH RD
Second Line :
City : FARMINGTON
State : CT
Zip : 06032-2556
Country : US
Telephone Number : 860-751-3900
Fax Number : 860-751-3905
Provider Business Practice Location Address
First Line : 184 LINCOLN ST
Second Line :
City : EASTON
State : MA
Zip : 02356-1799
Country : US
Telephone Number : 508-238-7053
Fax Number : 508-238-7049
Authorized Official
Title or Position : MANAGER
Name : LAWRENCE G. SANTILLI
Credential :
Telephone Number : 860-751-3900
Provider Enumeration Date : 11/02/2010
Last Update Date : 02/17/2023

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