Provider Demographics
NPI:1326034497
Name:CALDWELL SKILLED NURSING & REHAB CENTER
Entity Type:Organization
Organization Name:CALDWELL SKILLED NURSING & REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-356-2526
Mailing Address - Street 1:16 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-2228
Mailing Address - Country:US
Mailing Address - Phone:978-356-2526
Mailing Address - Fax:978-356-2761
Practice Address - Street 1:16 GREEN ST
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:MA
Practice Address - Zip Code:01938-2228
Practice Address - Country:US
Practice Address - Phone:978-356-2526
Practice Address - Fax:978-356-2761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA888314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0901431Medicaid
MA0901431Medicaid