Provider Demographics
NPI:1104039726
Name:BUSHEE, JUDY E
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:E
Last Name:BUSHEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-4723
Mailing Address - Country:US
Mailing Address - Phone:178-166-2947
Mailing Address - Fax:
Practice Address - Street 1:THE TOOLE NURSING HOME
Practice Address - Street 2:92 FRANKLIN STREET
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176
Practice Address - Country:US
Practice Address - Phone:178-166-5076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1561311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home