Provider Demographics
NPI:1144229873
Name:750 WOBURN STREET OPERATING COMPANY, LLC
Entity Type:Organization
Organization Name:750 WOBURN STREET OPERATING COMPANY, LLC
Other - Org Name:WILMINGTON HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, SPECIAL PROJECTS
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-930-6051
Mailing Address - Street 1:750 WOBURN STREET
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887
Mailing Address - Country:US
Mailing Address - Phone:978-988-0888
Mailing Address - Fax:978-658-6470
Practice Address - Street 1:750 WOBURN STREET
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887
Practice Address - Country:US
Practice Address - Phone:978-988-0888
Practice Address - Fax:978-658-6470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0911314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0926876Medicaid
MA0926876Medicaid