Provider Demographics
NPI:1124014469
Name:NEEDHAM REHABILITATION & NURSING CENTER LLC
Entity Type:Organization
Organization Name:NEEDHAM REHABILITATION & NURSING CENTER LLC
Other - Org Name:BRIARWOOD HEALTHCARE & NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:M
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-449-4040
Mailing Address - Street 1:150 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2914
Mailing Address - Country:US
Mailing Address - Phone:781-449-4040
Mailing Address - Fax:781-449-4129
Practice Address - Street 1:150 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2914
Practice Address - Country:US
Practice Address - Phone:781-449-4040
Practice Address - Fax:781-449-4129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0784314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0929263Medicaid
MA225437Medicare Oscar/Certification