Provider Demographics
NPI:1255328456
Name:RADIUS EASTON OPERATING LLC
Entity Type:Organization
Organization Name:RADIUS EASTON OPERATING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-238-7053
Mailing Address - Street 1:184 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1799
Mailing Address - Country:US
Mailing Address - Phone:508-238-7053
Mailing Address - Fax:508-238-7049
Practice Address - Street 1:184 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1799
Practice Address - Country:US
Practice Address - Phone:508-238-7053
Practice Address - Fax:508-238-7049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0928461314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0928461Medicaid
MA0928461Medicaid
MA225225Medicare ID - Type UnspecifiedMEDICARE