Provider Demographics
NPI:1558700765
Name:WG MARLAND PLACE SH, LLC
Entity Type:Organization
Organization Name:WG MARLAND PLACE SH, LLC
Other - Org Name:ATRIA MARLAND PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:W.
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-779-4700
Mailing Address - Street 1:401 S 4TH ST
Mailing Address - Street 2:SUITE 1900, ATTN: LEGAL DEPT.
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3426
Mailing Address - Country:US
Mailing Address - Phone:502-779-4700
Mailing Address - Fax:502-779-4749
Practice Address - Street 1:15 STEVENS ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3599
Practice Address - Country:US
Practice Address - Phone:978-475-4225
Practice Address - Fax:978-475-5818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MANONE ISSUED310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility