Basic Information
Provider Information | |||||||||
NPI: | 1306293642 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | BANE HANCOCK PARK, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | HANCOCK PARK ASSISTED LIVING | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 52 ACCORD PARK DR | ||||||||
Address2: |   | ||||||||
City: | NORWELL | ||||||||
State: | MA | ||||||||
PostalCode: | 020611628 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7818786700 | ||||||||
FaxNumber: | 7818789807 | ||||||||
Practice Location | |||||||||
Address1: | 164 PARKINGWAY | ||||||||
Address2: |   | ||||||||
City: | QUINCY | ||||||||
State: | MA | ||||||||
PostalCode: | 021695020 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6177734222 | ||||||||
FaxNumber: | 6177731115 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/17/2016 | ||||||||
LastUpdateDate: | 05/17/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BANE | ||||||||
AuthorizedOfficialFirstName: | HARRISON | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF OPERATIONS | ||||||||
AuthorizedOfficialTelephone: | 7818786700 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X |   |   | Y |   | Nursing & Custodial Care Facilities | Assisted Living Facility |   |
No ID Information.