Provider Demographics
NPI:1487628798
Name:DUXBURY HOUSE
Entity Type:Organization
Organization Name:DUXBURY HOUSE
Other - Org Name:THOMAS F. & RITA M. WELCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:T
Authorized Official - Last Name:CASOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-878-6700
Mailing Address - Street 1:52 ACCORD PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061
Mailing Address - Country:US
Mailing Address - Phone:781-878-6700
Mailing Address - Fax:781-878-9807
Practice Address - Street 1:298 KINGSTOWN WAY
Practice Address - Street 2:
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332
Practice Address - Country:US
Practice Address - Phone:781-585-2397
Practice Address - Fax:781-582-2057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0597311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0912905Medicaid