Provider Demographics
NPI:1508247479
Name:SOMERSET RIDGE CENTER
Entity Type:Organization
Organization Name:SOMERSET RIDGE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPY ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BORGES
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
Authorized Official - Phone:508-496-0065
Mailing Address - Street 1:455 BRAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02726-2642
Mailing Address - Country:US
Mailing Address - Phone:508-619-2240
Mailing Address - Fax:
Practice Address - Street 1:455 BRAYTON AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:MA
Practice Address - Zip Code:02726-2642
Practice Address - Country:US
Practice Address - Phone:508-619-2240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3466314000000X
RIOTA00562314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility