Provider Demographics
NPI:1508398082
Name:BEAR MOUNTAIN 320 OPERATING, LLC
Entity Type:Organization
Organization Name:BEAR MOUNTAIN 320 OPERATING, LLC
Other - Org Name:TIMBERLYN HEIGHTS NURSING AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WYNNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-528-2650
Mailing Address - Street 1:320 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1951
Mailing Address - Country:US
Mailing Address - Phone:413-528-2650
Mailing Address - Fax:203-528-3282
Practice Address - Street 1:320 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1951
Practice Address - Country:US
Practice Address - Phone:413-528-2650
Practice Address - Fax:203-528-3282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0006314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility