Provider Demographics
NPI:1346236908
Name:GERIATRIC AUTHORITY OF MILFORD
Entity Type:Organization
Organization Name:GERIATRIC AUTHORITY OF MILFORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ISABELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-473-0435
Mailing Address - Street 1:1 COUNTRYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1252
Mailing Address - Country:US
Mailing Address - Phone:508-473-0435
Mailing Address - Fax:508-473-9755
Practice Address - Street 1:1 COUNTRYSIDE DR
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1252
Practice Address - Country:US
Practice Address - Phone:508-473-0435
Practice Address - Fax:508-473-9755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA883314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0908827Medicaid
MA225463Medicare Oscar/Certification