Basic Information
| Provider Information | |||||||||
| NPI: | 1699080010 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | 1561 COLD SPRING ROAD OPERATING COMPANY, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SWEET BROOK OF WILLIAMSTOWN REHABILITATION AND NURSING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 173 BRIDGE PLZ N | ||||||||
| Address2: | |||||||||
| City: | FORT LEE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070247575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2012424920 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1561 COLD SPRING RD | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSTOWN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 012672743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4134588127 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2010 | ||||||||
| LastUpdateDate: | 08/10/2010 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | STUART | ||||||||
| AuthorizedOfficialFirstName: | ANNE | ||||||||
| AuthorizedOfficialMiddleName: | H. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2012424920 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 0080 | MA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.