Provider Demographics
NPI:1881689644
Name:UNIVERSITY COMMONS NURSING CARE CENTER PARTN
Entity Type:Organization
Organization Name:UNIVERSITY COMMONS NURSING CARE CENTER PARTN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL REPORTING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-856-3092
Mailing Address - Street 1:328 SHREWSBURY STREET
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604
Mailing Address - Country:US
Mailing Address - Phone:508-856-3092
Mailing Address - Fax:508-334-7040
Practice Address - Street 1:378 PLANTATION STREET
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604
Practice Address - Country:US
Practice Address - Phone:508-856-3092
Practice Address - Fax:508-334-7040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0921149Medicaid
225594Medicare PIN
MA0921149Medicaid