Basic Information
| Provider Information | |||||||||
| NPI: | 1295812691 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GROSVENOR PARK NURSING CENTER, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 LORING HILLS AVE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019704267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787415700 | ||||||||
| FaxNumber: | 9787458888 | ||||||||
| Practice Location | |||||||||
| Address1: | 7 LORING HILLS AVE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019704267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787415700 | ||||||||
| FaxNumber: | 9787458888 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ESCALADA | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9787415700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 0968 | MA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 0921807 | 05 | MA | MEDICAID |