Provider Demographics
NPI:1114045135
Name:FORGE HILL ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:FORGE HILL ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARYANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANNICANDRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-528-9200
Mailing Address - Street 1:4 FORGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-3162
Mailing Address - Country:US
Mailing Address - Phone:508-528-9200
Mailing Address - Fax:508-541-6591
Practice Address - Street 1:4 FORGE HILL RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-3162
Practice Address - Country:US
Practice Address - Phone:508-528-9200
Practice Address - Fax:508-541-6591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1904272Medicaid