Provider Demographics
NPI:1629292727
Name:MERRIMAC MEDICAL INVESTORS, LLC
Entity Type:Organization
Organization Name:MERRIMAC MEDICAL INVESTORS, LLC
Other - Org Name:FAIRVIEW NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BEAULIEU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-876-3836
Mailing Address - Street 1:203 LOWELL RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NH
Mailing Address - Zip Code:03051-4909
Mailing Address - Country:US
Mailing Address - Phone:603-882-5261
Mailing Address - Fax:603-598-3896
Practice Address - Street 1:203 LOWELL RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NH
Practice Address - Zip Code:03051-4909
Practice Address - Country:US
Practice Address - Phone:603-882-5261
Practice Address - Fax:603-598-3896
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FG HEALTHCARE PROPERTIES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-12
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH30E032313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30104983Medicaid
NH305100Medicare PIN