Provider Demographics
NPI:1780670869
Name:MEADOW GREEN NURSING HOME, INC.
Entity Type:Organization
Organization Name:MEADOW GREEN NURSING HOME, INC.
Other - Org Name:MEADOW GREEN REHABILITATION AND NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCZEPANSKI
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:781-237-8503
Mailing Address - Street 1:45 WOBURN ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-7919
Mailing Address - Country:US
Mailing Address - Phone:781-899-8600
Mailing Address - Fax:781-899-3124
Practice Address - Street 1:45 WOBURN ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-7919
Practice Address - Country:US
Practice Address - Phone:781-899-8600
Practice Address - Fax:781-899-3124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0889314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0917532Medicaid
MA225440Medicare PIN