Provider Demographics
NPI:1558448878
Name:LEDGEWOOD HEALTHCARE CORPORATION
Entity Type:Organization
Organization Name:LEDGEWOOD HEALTHCARE CORPORATION
Other - Org Name:LEDGEWOOD REHABILITATION AND SKILLED NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:WEGLARZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-326-5982
Mailing Address - Street 1:87 HERRICK ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2773
Mailing Address - Country:US
Mailing Address - Phone:978-921-1392
Mailing Address - Fax:978-927-8627
Practice Address - Street 1:87 HERRICK ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2773
Practice Address - Country:US
Practice Address - Phone:978-921-1392
Practice Address - Fax:978-927-8627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0878314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0926540Medicaid
MA2222530901OtherBLUE CROSS BLUE SHIELD
MA5458210OtherAETNA
MA902081OtherHPHC
MA991178OtherUNITED HEALTHCARE
MA802864OtherTUFTS
225309Medicare Oscar/Certification