Provider Demographics
NPI:1417170408
Name:MT GREYLOCK NURSING LLC
Entity Type:Organization
Organization Name:MT GREYLOCK NURSING LLC
Other - Org Name:MOUNT GREYLOCK EXTENDED CARE FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:AMALE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-447-2416
Mailing Address - Street 1:1000 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-1520
Mailing Address - Country:US
Mailing Address - Phone:413-499-7186
Mailing Address - Fax:413-499-3086
Practice Address - Street 1:1000 NORTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-1520
Practice Address - Country:US
Practice Address - Phone:413-499-7186
Practice Address - Fax:413-499-3086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0893314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0928968Medicaid
MA0649390001Medicare NSC
225306Medicare ID - Type Unspecified