Provider Demographics
NPI:1033106356
Name:BEAUMONT WARDS LANE TRUST
Entity Type:Organization
Organization Name:BEAUMONT WARDS LANE TRUST
Other - Org Name:BEAUMONT NURSING HOME, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SACON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-898-3490
Mailing Address - Street 1:3 LYMAN ST
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-1442
Mailing Address - Country:US
Mailing Address - Phone:508-898-3490
Mailing Address - Fax:508-898-1805
Practice Address - Street 1:85 BEAUMONT DR
Practice Address - Street 2:
Practice Address - City:NORTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01534-1093
Practice Address - Country:US
Practice Address - Phone:508-234-9771
Practice Address - Fax:508-234-2635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0160314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0900419Medicaid
MA225248Medicare ID - Type Unspecified