Provider Demographics
NPI:1891954103
Name:DAGGETT CRANDLL NEWCOMB HOME
Entity Type:Organization
Organization Name:DAGGETT CRANDLL NEWCOMB HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:THERIAULT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:508-285-3264
Mailing Address - Street 1:55 NEWLAND ST
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-1900
Mailing Address - Country:US
Mailing Address - Phone:508-285-3264
Mailing Address - Fax:508-285-2766
Practice Address - Street 1:55 NEWLAND ST
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:MA
Practice Address - Zip Code:02766-1900
Practice Address - Country:US
Practice Address - Phone:508-285-3264
Practice Address - Fax:508-285-2766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1189310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility