Provider Demographics
NPI:1235123894
Name:ST. PATRICK'S MANOR, INC
Entity Type:Organization
Organization Name:ST. PATRICK'S MANOR, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SR. MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-879-8000
Mailing Address - Street 1:863 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-4813
Mailing Address - Country:US
Mailing Address - Phone:508-879-8000
Mailing Address - Fax:508-626-1604
Practice Address - Street 1:863 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-4813
Practice Address - Country:US
Practice Address - Phone:508-879-8000
Practice Address - Fax:508-626-1604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0699314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0998486Medicaid
MA0998486Medicaid