Provider Demographics
NPI:1467449702
Name:OLD COLONY ROAD REST HOME, INC.
Entity Type:Organization
Organization Name:OLD COLONY ROAD REST HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J,
Authorized Official - Last Name:DEVLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-222-1074
Mailing Address - Street 1:377 OLD COLONY RD
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-2043
Mailing Address - Country:US
Mailing Address - Phone:508-222-1074
Mailing Address - Fax:508-431-8200
Practice Address - Street 1:377 OLD COLONY RD
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:MA
Practice Address - Zip Code:02766-2043
Practice Address - Country:US
Practice Address - Phone:508-222-1074
Practice Address - Fax:508-431-8200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home