Provider Demographics
NPI:1588609218
Name:CFM BUCKLEY NORTH LLC
Entity Type:Organization
Organization Name:CFM BUCKLEY NORTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-459-6094
Mailing Address - Street 1:95 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-3106
Mailing Address - Country:US
Mailing Address - Phone:413-774-3143
Mailing Address - Fax:
Practice Address - Street 1:95 LAUREL ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-3106
Practice Address - Country:US
Practice Address - Phone:413-774-3143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELDERTRUST OF FLORIDA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-17
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0866314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
982211OtherTUTTS HEALTH PLAN
MA0928038Medicaid
91157509OtherWAUSAU BENEFITS
MA2222533501OtherBLUE CROSS
MA2222533501OtherBLUE CROSS
MA0928038Medicaid