Provider Demographics
NPI:1851374409
Name:LASELL VILLAGE INC.
Entity Type:Organization
Organization Name:LASELL VILLAGE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS & FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:
Authorized Official - Last Name:MEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-663-7056
Mailing Address - Street 1:120 SEMINARY AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-2650
Mailing Address - Country:US
Mailing Address - Phone:617-663-7000
Mailing Address - Fax:617-663-7001
Practice Address - Street 1:120 SEMINARY AVE
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:MA
Practice Address - Zip Code:02466-2650
Practice Address - Country:US
Practice Address - Phone:617-663-7000
Practice Address - Fax:617-663-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAOEIG314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA225755Medicare Oscar/Certification