Provider Demographics
NPI:1700416526
Name:WELL LCB PORTFOLIO 1 TENANT, LLC
Entity Type:Organization
Organization Name:WELL LCB PORTFOLIO 1 TENANT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT VICE PRESIDENT, LEGAL
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-677-8753
Mailing Address - Street 1:3 EDGEWATER DR STE 101
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-4644
Mailing Address - Country:US
Mailing Address - Phone:781-619-9324
Mailing Address - Fax:
Practice Address - Street 1:4 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:NORTH CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-2438
Practice Address - Country:US
Practice Address - Phone:978-458-0099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility