Provider Demographics
NPI:1700421948
Name:SRC PITTSFIELD OP, LLC
Entity Type:Organization
Organization Name:SRC PITTSFIELD OP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHARF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-707-9030
Mailing Address - Street 1:63 KENDRICK ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-2760
Mailing Address - Country:US
Mailing Address - Phone:781-707-9085
Mailing Address - Fax:781-281-8827
Practice Address - Street 1:140 MELBOURNE RD
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-8533
Practice Address - Country:US
Practice Address - Phone:413-499-1992
Practice Address - Fax:413-443-8870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility