Provider Demographics
NPI:1225161581
Name:MASON WRIGHT RETIREMENT COMMUNITY
Entity Type:Organization
Organization Name:MASON WRIGHT RETIREMENT COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:LABARRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-733-1517
Mailing Address - Street 1:74 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01105-1524
Mailing Address - Country:US
Mailing Address - Phone:413-733-1517
Mailing Address - Fax:413-747-8357
Practice Address - Street 1:74 WALNUT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1524
Practice Address - Country:US
Practice Address - Phone:413-733-1517
Practice Address - Fax:413-747-8357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
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
MA1904434OtherMASSHEALTH PROVIDER ID