Provider Demographics
NPI:1629258306
Name:EPOCH OF BREWSTER, LLC
Entity Type:Organization
Organization Name:EPOCH OF BREWSTER, LLC
Other - Org Name:EPOCH SENIOR HEALTHCARE OF BREWSTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DEBORA
Authorized Official - Middle Name:
Authorized Official - Last Name:PFAFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-810-1240
Mailing Address - Street 1:51 SAWYER RD STE 500
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-3461
Mailing Address - Country:US
Mailing Address - Phone:781-810-1240
Mailing Address - Fax:
Practice Address - Street 1:873 HARWICH RD
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:MA
Practice Address - Zip Code:02631-5232
Practice Address - Country:US
Practice Address - Phone:508-896-7046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0837314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0940411Medicaid
MA0940411Medicaid