MEDICARE: CAPE REGENCY 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
1	314000000X	Skilled Nursing Facility	0858	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	:	1942299185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPE REGENCY MA SNF LLC

Provider Business Mailing Address
First Line	:	120 SOUTH MAIN STREET
Second Line	:
City	:	CENTERVILLE
State	:	MA
Zip	:	02632
Country	:	US
Telephone Number	:	508-879-4050
Fax Number	:	508-879-1534

Provider Business Practice Location Address
First Line	:	120 SOUTH MAIN STREET
Second Line	:
City	:	CENTERVILLE
State	:	MA
Zip	:	02632
Country	:	US
Telephone Number	:	508-778-1835
Fax Number	:	508-771-7411

Authorized Official
Title or Position	:	MANAGER
Name	:	LAWRENCE G. SANTILLI
Credential	:
Telephone Number	:	860-751-3900

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	02/17/2023

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