Provider Demographics
NPI:1043207178
Name:COLONIAL HEALTH GROUP- TCU, LLC
Entity Type:Organization
Organization Name:COLONIAL HEALTH GROUP- TCU, LLC
Other - Org Name:THE TCU @ HUBBARD HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-420-1500
Mailing Address - Street 1:340 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01570-1509
Mailing Address - Country:US
Mailing Address - Phone:508-949-8424
Mailing Address - Fax:508-949-8423
Practice Address - Street 1:340 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570-1509
Practice Address - Country:US
Practice Address - Phone:508-949-8424
Practice Address - Fax:508-949-8423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0Q5A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0928348Medicaid
MA225735Medicare ID - Type Unspecified