Provider Demographics
NPI:1922089440
Name:KIRKWOOD HOUSE INC
Entity Type:Organization
Organization Name:KIRKWOOD HOUSE INC
Other - Org Name:KIRKWOOD NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-245-4129
Mailing Address - Street 1:202 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-1823
Mailing Address - Country:US
Mailing Address - Phone:781-245-4129
Mailing Address - Fax:781-245-7190
Practice Address - Street 1:202 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1823
Practice Address - Country:US
Practice Address - Phone:781-245-4129
Practice Address - Fax:781-245-7190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0318314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA20464OtherVACCINE IMMUNIZATION
MA0999091Medicaid
MA20464OtherVACCINE IMMUNIZATION