Basic Information
| Provider Information | |||||||||
| NPI: | 1629042098 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DUXBURY HEALTHCARE PARTNERSHIP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BAY PATH REHABILITATION AND NURSING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 52 ACCORD PARK DR | ||||||||
| Address2: | |||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020611628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818786700 | ||||||||
| FaxNumber: | 7818789807 | ||||||||
| Practice Location | |||||||||
| Address1: | 308 KINGS TOWN WAY | ||||||||
| Address2: | |||||||||
| City: | DUXBURY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023324647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7815855561 | ||||||||
| FaxNumber: | 7815851481 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2006 | ||||||||
| LastUpdateDate: | 06/24/2011 | ||||||||
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| AuthorizedOfficialLastName: | WELCH | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7818786700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 0867 | MA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 0915203 | 05 | MA | MEDICAID | 903023 | 01 | MA | HARVARD PILGRIM - HMO | OTHER | 2222527901 | 01 | MA | BLUE CROSS - HMO | OTHER | 608371 | 01 | MA | TUFTS HEALTH - HMO | OTHER |