Provider Demographics
NPI:1326163056
Name:B-XII PLYMOUTH LLC
Entity Type:Organization
Organization Name:B-XII PLYMOUTH LLC
Other - Org Name:BENCHMARK SENIOR LIVING AT PLYMOUTH CROSSINGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR PARALEGAL
Authorized Official - Prefix:MS
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRENSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-489-7563
Mailing Address - Street 1:40 WILLIAM ST
Mailing Address - Street 2:SUITE 350
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-3999
Mailing Address - Country:US
Mailing Address - Phone:781-489-7100
Mailing Address - Fax:
Practice Address - Street 1:157 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7605
Practice Address - Country:US
Practice Address - Phone:508-830-4744
Practice Address - Fax:508-830-4748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility