Provider Demographics
NPI:1093015935
Name:STONEHEDGE MA SNF LLC
Entity Type:Organization
Organization Name:STONEHEDGE MA SNF LLC
Other - Org Name:STONEHEDGE HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOSIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-751-3900
Mailing Address - Street 1:135 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2556
Mailing Address - Country:US
Mailing Address - Phone:860-751-3900
Mailing Address - Fax:860-751-3905
Practice Address - Street 1:5 REDLANDS RD
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-1506
Practice Address - Country:US
Practice Address - Phone:617-327-6325
Practice Address - Fax:617-327-8204
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATHENA HEALTH CARE SYSTEMS MA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-26
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110087945AMedicaid
MA225429Medicare Oscar/Certification