Basic Information
| Provider Information | |||||||||
| NPI: | 1013502251 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEACOAST SNF LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 GRANITE ST STE 2203 | ||||||||
| Address2: | |||||||||
| City: | BRAINTREE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021844963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814742263 | ||||||||
| FaxNumber: | 7818713986 | ||||||||
| Practice Location | |||||||||
| Address1: | 292 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | GLOUCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019304832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782830300 | ||||||||
| FaxNumber: | 9782816774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2021 | ||||||||
| LastUpdateDate: | 03/09/2021 | ||||||||
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| AuthorizedOfficialLastName: | DIFRANCESCO | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | JOSEPH | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7815019761 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 02/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 0946 | 05 | MA | MEDICAID |