Provider Demographics
NPI:1093930364
Name:MASSACHUSETTS ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:MASSACHUSETTS ASSISTED LIVING LLC
Other - Org Name:THE VILLAGE AT LAUREL LAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP OF REIMBURSEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROTHGERBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-596-7300
Mailing Address - Street 1:600 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:LEE
Mailing Address - State:MA
Mailing Address - Zip Code:01238-3800
Mailing Address - Country:US
Mailing Address - Phone:413-243-4747
Mailing Address - Fax:413-243-4604
Practice Address - Street 1:600 LAUREL ST
Practice Address - Street 2:
Practice Address - City:LEE
Practice Address - State:MA
Practice Address - Zip Code:01238-3800
Practice Address - Country:US
Practice Address - Phone:413-243-4747
Practice Address - Fax:413-243-4604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1903870Medicaid