Provider Demographics
NPI:1346662046
Name:WABAN HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:WABAN HEALTH CENTER, LLC
Other - Org Name:WABAN HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AVI
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPSHUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-710-4431
Mailing Address - Street 1:20 KINMONTH RD
Mailing Address - Street 2:
Mailing Address - City:WABAN
Mailing Address - State:MA
Mailing Address - Zip Code:02468-1503
Mailing Address - Country:US
Mailing Address - Phone:617-332-8481
Mailing Address - Fax:617-332-8959
Practice Address - Street 1:20 KINMONTH RD
Practice Address - Street 2:
Practice Address - City:WABAN
Practice Address - State:MA
Practice Address - Zip Code:02468-1503
Practice Address - Country:US
Practice Address - Phone:617-332-8481
Practice Address - Fax:617-332-8959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0387314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA225553Medicare Oscar/Certification