MEDICARE: COCHITUATE NURSING HOME 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	0383	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	:	1669469920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COCHITUATE NURSING HOME INC

Provider Business Mailing Address
First Line	:	188 COMMONWEALTH RD
Second Line	:
City	:	WAYLAND
State	:	MA
Zip	:	01778-5027
Country	:	US
Telephone Number	:	508-653-8500
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	:	ADMINISTRATOR
Name	:	MR. ALAN A GUIDREY
Credential	:
Telephone Number	:	508-983-8500

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	11/04/2011

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