Provider Demographics
NPI:1659459675
Name:FOX HILL VILLAGE PARTNERSHIP
Entity Type:Organization
Organization Name:FOX HILL VILLAGE PARTNERSHIP
Other - Org Name:CLARK HOUSE NURSING CENTER AT FOX HILL VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-596-7563
Mailing Address - Street 1:30 LONGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-1132
Mailing Address - Country:US
Mailing Address - Phone:781-326-5652
Mailing Address - Fax:781-326-4034
Practice Address - Street 1:30 LONGWOOD DR
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-1132
Practice Address - Country:US
Practice Address - Phone:781-326-5652
Practice Address - Fax:781-326-4034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0924314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA902134OtherHPHC
MA924346OtherUNITED HEALTHCARE
MA4422884OtherAETNA
MA4422884OtherAETNA