Provider Demographics
NPI:1346470135
Name:SEASHORE POINT WELLNESS AND REHAB
Entity Type:Organization
Organization Name:SEASHORE POINT WELLNESS AND REHAB
Other - Org Name:SEASHORE POINT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:REHAB MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTMINY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:508-487-7777
Mailing Address - Street 1:100 ALDEN ST
Mailing Address - Street 2:
Mailing Address - City:PROVINCETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02657-1456
Mailing Address - Country:US
Mailing Address - Phone:508-487-7777
Mailing Address - Fax:508-487-7706
Practice Address - Street 1:100 ALDEN ST
Practice Address - Street 2:
Practice Address - City:PROVINCETOWN
Practice Address - State:MA
Practice Address - Zip Code:02657-1456
Practice Address - Country:US
Practice Address - Phone:508-487-7777
Practice Address - Fax:508-487-7706
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEASHORE POINT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1106OtherMA STATE LIC NUMBER