Provider Demographics
NPI:1760426282
Name:NORTHWOOD MA SNF LLC
Entity Type:Organization
Organization Name:NORTHWOOD MA SNF LLC
Other - Org Name:NORTHWOOD REHABILITATION & HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:G
Authorized Official - Last Name:SANTILLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-751-3900
Mailing Address - Street 1:1010 VARNUM AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-1915
Mailing Address - Country:US
Mailing Address - Phone:508-879-4050
Mailing Address - Fax:508-879-1534
Practice Address - Street 1:1010 VARNUM AVENUE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854
Practice Address - Country:US
Practice Address - Phone:978-458-8773
Practice Address - Fax:978-458-6366
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATHENA HEALTH CARE ASSOCIATES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-15
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0838314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110094540AMedicaid
MA2222529801OtherBC/BS OF MA PROVIDER NUMB
MA907339OtherHARVARD PILGRIM PROV NUMB
MA914985OtherTUFTS MEDICARE PREFERRED
MA249OtherFALLON VENDOR CODE
MA7100155OtherEVERCARE PROV #
MA907339OtherHARVARD PILGRIM PROV NUMB