Provider Demographics
NPI:1669467973
Name:WINTHROP HEALTHCARE INVESTORS D B A
Entity Type:Organization
Organization Name:WINTHROP HEALTHCARE INVESTORS D B A
Other - Org Name:GOVERNOR WINTHROP NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT SEC-TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOU
Authorized Official - Middle Name:
Authorized Official - Last Name:MITTLEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-870-2813
Mailing Address - Street 1:142 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-2042
Mailing Address - Country:US
Mailing Address - Phone:617-846-7750
Mailing Address - Fax:617-846-2302
Practice Address - Street 1:142 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-2042
Practice Address - Country:US
Practice Address - Phone:617-846-7750
Practice Address - Fax:617-846-2302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0565314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0923605Medicaid
MA0923605Medicaid