Provider Demographics
NPI:1285184085
Name:WV-CONCORD SNF OPCO, LLC
Entity Type:Organization
Organization Name:WV-CONCORD SNF OPCO, LLC
Other - Org Name:WALDEN HEALTH AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:A
Authorized Official - Last Name:DENNEHY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:978-886-3336
Mailing Address - Street 1:36 WASHINGTON ST
Mailing Address - Street 2:SUITE 190
Mailing Address - City:WELLESLEY HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02481-1900
Mailing Address - Country:US
Mailing Address - Phone:781-943-3104
Mailing Address - Fax:
Practice Address - Street 1:785 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3310
Practice Address - Country:US
Practice Address - Phone:978-369-6889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WACHUSETT VENTURES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110100396AMedicaid
MA110100396AMedicaid