Provider Demographics
NPI:1275866303
Name:CENTRAL STREET ASSISTED LIVING
Entity Type:Organization
Organization Name:CENTRAL STREET ASSISTED LIVING
Other - Org Name:THE ARBORS AT STOUGHTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-344-0310
Mailing Address - Street 1:2121 CENTRAL STREET
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072
Mailing Address - Country:US
Mailing Address - Phone:781-344-0310
Mailing Address - Fax:781-344-4634
Practice Address - Street 1:2121 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-1242
Practice Address - Country:US
Practice Address - Phone:781-344-0310
Practice Address - Fax:781-344-4634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA311ZA0620X310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110082435AOtherMASSHEALTH PROVIDER NUMBER