Provider Demographics
NPI:1386193845
Name:WACHUSETT HEALTHCARE MANAGEMENT COMPANY, LLC
Entity Type:Organization
Organization Name:WACHUSETT HEALTHCARE MANAGEMENT COMPANY, LLC
Other - Org Name:WACHUSETT HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:A
Authorized Official - Last Name:DENNEHY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:978-886-3336
Mailing Address - Street 1:36 WASHINGTON ST
Mailing Address - Street 2:SUITE 190
Mailing Address - City:WELLESLEY HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02481-1900
Mailing Address - Country:US
Mailing Address - Phone:781-943-3104
Mailing Address - Fax:
Practice Address - Street 1:36 WASHINGTON ST
Practice Address - Street 2:SUITE 190
Practice Address - City:WELLESLEY HILLS
Practice Address - State:MA
Practice Address - Zip Code:02481-1900
Practice Address - Country:US
Practice Address - Phone:781-943-3104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WACHUSETT VENTURES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility