Provider Demographics
NPI:1285638890
Name:WOBURN NURSING CENTER, INC
Entity Type:Organization
Organization Name:WOBURN NURSING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DRISCOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-994-2114
Mailing Address - Street 1:18 FRANCES ST
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-3006
Mailing Address - Country:US
Mailing Address - Phone:781-933-8175
Mailing Address - Fax:781-729-3817
Practice Address - Street 1:18 FRANCES ST
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-3006
Practice Address - Country:US
Practice Address - Phone:781-933-8175
Practice Address - Fax:781-729-3817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4213314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA803059OtherTUFTS/SECURE HORIZON
MA0906905Medicaid
MA903183OtherHARVARD PILGRIM HEALTH
MA2222539401OtherBLUE CROSS BLUE SHIELD
MA552468OtherAETNA/ US HEALTHCARE
MA0906905Medicaid
MA2222539401OtherBLUE CROSS BLUE SHIELD