Provider Demographics
NPI:1255661518
Name:METHUEN ASSISTED LIVING, LP
Entity Type:Organization
Organization Name:METHUEN ASSISTED LIVING, LP
Other - Org Name:METHUEN VILLAGE AT RIVERWALK PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-685-2220
Mailing Address - Street 1:4 GLEASON ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-3060
Mailing Address - Country:US
Mailing Address - Phone:978-685-2220
Mailing Address - Fax:
Practice Address - Street 1:4 GLEASON ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-3060
Practice Address - Country:US
Practice Address - Phone:978-685-2220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-10
Last Update Date:2010-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility