Provider Demographics
NPI:1063486322
Name:MAYFLOWER PLACE NURSING CENTER, INC
Entity Type:Organization
Organization Name:MAYFLOWER PLACE NURSING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:INSOFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-641-0009
Mailing Address - Street 1:579 BUCK ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:W YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02673-3200
Mailing Address - Country:US
Mailing Address - Phone:508-957-7007
Mailing Address - Fax:508-790-8116
Practice Address - Street 1:579 BUCK ISLAND RD
Practice Address - Street 2:
Practice Address - City:W YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02673-3200
Practice Address - Country:US
Practice Address - Phone:508-957-7007
Practice Address - Fax:508-790-8116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0914314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2222537401OtherBLUE CROSS - HMO
MA0919411Medicaid
MA225374Medicare ID - Type Unspecified