Provider Demographics
NPI:1437457827
Name:B-IX EDGEHILL SNF LLC
Entity Type:Organization
Organization Name:B-IX EDGEHILL SNF LLC
Other - Org Name:EDGEHILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:GRAPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-489-7563
Mailing Address - Street 1:201 JONES RD STE 300WEST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1600
Mailing Address - Country:US
Mailing Address - Phone:781-489-7106
Mailing Address - Fax:781-489-6663
Practice Address - Street 1:122 PALMERS HILL RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2134
Practice Address - Country:US
Practice Address - Phone:203-323-2323
Practice Address - Fax:203-323-6437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPENDING314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility