Provider Demographics
NPI:1447614243
Name:BANE HANCOCK PARK, LLC
Entity Type:Organization
Organization Name:BANE HANCOCK PARK, LLC
Other - Org Name:HANCOCK PARK REHABILITATION AND NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:BANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-474-2263
Mailing Address - Street 1:350 GRANITE ST STE 2203
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-4963
Mailing Address - Country:US
Mailing Address - Phone:781-474-2263
Mailing Address - Fax:781-878-9807
Practice Address - Street 1:164 PARKINGWAY
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5020
Practice Address - Country:US
Practice Address - Phone:617-773-4222
Practice Address - Fax:617-773-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-07
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA700122222571801OtherBLUE CROSS
MA110119795AMedicaid
MA110119795AMedicaid