Provider Demographics
NPI:1225727654
Name:BLACKWOOD HEALTH LLC
Entity Type:Organization
Organization Name:BLACKWOOD HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:ATELENE
Authorized Official - Last Name:BLACKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:RNBSN
Authorized Official - Phone:617-519-0651
Mailing Address - Street 1:13 WIGGIN AVE
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-1600
Mailing Address - Country:US
Mailing Address - Phone:888-479-7699
Mailing Address - Fax:
Practice Address - Street 1:13 WIGGIN AVE
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-1600
Practice Address - Country:US
Practice Address - Phone:888-479-7699
Practice Address - Fax:781-471-7915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care