Provider Demographics
NPI:1033164272
Name:COURTYARD NURSING CARE CENTER PARTNERSHIP
Entity Type:Organization
Organization Name:COURTYARD NURSING CARE CENTER PARTNERSHIP
Other - Org Name:COURTYARD NURSING CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARALEGAL
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVELACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-468-4742
Mailing Address - Street 1:101 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-3109
Mailing Address - Country:US
Mailing Address - Phone:610-925-4436
Mailing Address - Fax:610-925-4351
Practice Address - Street 1:200 GOVERNORS AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-1644
Practice Address - Country:US
Practice Address - Phone:781-391-5400
Practice Address - Fax:781-391-4254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0933314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
0010786OtherNEIGHBORHOOD HEALTH PLAN
MA0940194Medicaid
MA2222554501OtherBC/BS OF MA
551842OtherAETNA-HMO
71-00017OtherUNITED - EVERCARE
905414OtherHARVARD PILGRAM
MA2222554510OtherBC/BS - OUTPATIEN REHAB
802272OtherTUFTS
802272OtherTUFTS
=========OtherGREAT-WEST HEALTHCARE
551842OtherAETNA-HMO
=========OtherSENIOR WHOLE HEALTH