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NPI Code Detail

MEDICARE: SRC WESTON, LLC

MEDICARE: SRC WESTON, 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

General Provider Information

NPI Number : 1962867036
Entity Type Code : Organization
Provider Name (Legal Business Name) : SRC WESTON, LLC
Provider Business Mailing Address
First Line : 63 KENDRICK ST
Second Line :
City : NEEDHAM
State : MA
Zip : 02494-2708
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 75 NORUMBEGA RD
Second Line :
City : WESTON
State : MA
Zip : 02493-2431
Country : US
Telephone Number : 781-891-6100
Fax Number :
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICER
Name : TAMILYN LEVIN
Credential :
Telephone Number : 781-707-9510
Provider Enumeration Date : 12/16/2015
Last Update Date : 12/16/2015

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Directions to “SRC WESTON, LLC ” Practice Location

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