Basic Information
| Provider Information | |||||||||
| NPI: | 1659691582 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NTAL PROPERTY, LLC | ||||||||
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| OtherOrganizationName: | BAYBERRY AT EMERALD COURT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018034407 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2000 EMERALD CT | ||||||||
| Address2: | |||||||||
| City: | TEWKSBURY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018765220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786400194 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2010 | ||||||||
| LastUpdateDate: | 06/02/2010 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RICARDI | ||||||||
| AuthorizedOfficialFirstName: | SHARON | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VP. OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 7812722424 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | MA | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.