Provider Demographics
NPI:1578557112
Name:HANNAH B. GRIFFITH SHAW HOME FOR THE AGED, INC.
Entity Type:Organization
Organization Name:HANNAH B. GRIFFITH SHAW HOME FOR THE AGED, INC.
Other - Org Name:HANNAH SHAW HOME, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:HERRMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-947-0332
Mailing Address - Street 1:299 WAREHAM ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-2905
Mailing Address - Country:US
Mailing Address - Phone:508-947-0332
Mailing Address - Fax:508-923-4652
Practice Address - Street 1:299 WAREHAM ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-2905
Practice Address - Country:US
Practice Address - Phone:508-947-0332
Practice Address - Fax:508-923-4652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA840314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0910198Medicaid
MA0910198Medicaid