Basic Information
| Provider Information | |||||||||
| NPI: | 1881668382 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLONIAL NURSING HOME OF WEYMOUTH, INC | ||||||||
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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: | 128 BROAD ST | ||||||||
| Address2: | |||||||||
| City: | WEYMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021882336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813373121 | ||||||||
| FaxNumber: | 7813377510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2006 | ||||||||
| LastUpdateDate: | 10/26/2009 | ||||||||
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| AuthorizedOfficialLastName: | WELCH | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7813373121 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 0442 | MA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 803042 | 01 | MA | TUFTS HEALTH - HMO | OTHER | 902179 | 01 | MA | HARVARD PILGRIM | OTHER | 0020168 | 01 | MA | NEIGHBORHOOD HEALTH - HMO | OTHER | 0999644 | 05 | MA | MEDICAID | 2222505901 | 01 | MA | BLUE CROSS - HMO | OTHER |