Provider Demographics
NPI:1609905512
Name:LARCHWOOD LODGE NURSING HOME
Entity Type:Organization
Organization Name:LARCHWOOD LODGE NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GALATIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-894-5264
Mailing Address - Street 1:96 HILLSIDE AVE
Mailing Address - Street 2:96 HILLSIDE AVE
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-1710
Mailing Address - Country:US
Mailing Address - Phone:781-894-5264
Mailing Address - Fax:781-894-6011
Practice Address - Street 1:325 BACON ST
Practice Address - Street 2:325 BACON STREET
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-7519
Practice Address - Country:US
Practice Address - Phone:781-894-5264
Practice Address - Fax:781-894-6011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0214314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0921947Medicaid
MA225601Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO.