Basic Information
| Provider Information | |||||||||
| NPI: | 1326467960 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SB OPERATING COMPANY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1561 COLD SPRING RD | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSTOWN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012672743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4134588127 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1561 COLD SPRING RD | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSTOWN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012672743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4134588127 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2014 | ||||||||
| LastUpdateDate: | 04/10/2014 | ||||||||
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| AuthorizedOfficialLastName: | SHERMAN | ||||||||
| AuthorizedOfficialFirstName: | ALEXANDER | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 5166215400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.