Provider Demographics
NPI:1669660510
Name:LIVING WELL REHAB CENTER
Entity Type:Organization
Organization Name:LIVING WELL REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRICO
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-296-6200
Mailing Address - Street 1:534 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-3014
Mailing Address - Country:US
Mailing Address - Phone:617-296-6200
Mailing Address - Fax:617-296-6300
Practice Address - Street 1:534 RIVER ST
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-3014
Practice Address - Country:US
Practice Address - Phone:617-296-6200
Practice Address - Fax:617-296-6300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation