Provider Demographics
NPI:1639117310
Name:PARKWELL HEALTHCARE LLC
Entity Type:Organization
Organization Name:PARKWELL HEALTHCARE LLC
Other - Org Name:PARKWELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:J
Authorized Official - Last Name:TOPJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-361-8300
Mailing Address - Street 1:745 TRUMAN HWY
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-3536
Mailing Address - Country:US
Mailing Address - Phone:617-361-8300
Mailing Address - Fax:617-361-7725
Practice Address - Street 1:745 TRUMAN HWY
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-3536
Practice Address - Country:US
Practice Address - Phone:617-361-8300
Practice Address - Fax:617-361-7725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0516314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0940534Medicaid
MA110026654BMedicaid
MA110026654BMedicaid