Provider Demographics
NPI:1922097344
Name:HEARTHSTONE AT GOLDEN POND INC
Entity Type:Organization
Organization Name:HEARTHSTONE AT GOLDEN POND INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HYDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-674-2884
Mailing Address - Street 1:23 WARREN AVE
Mailing Address - Street 2:STE 140
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-4979
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:MA
Practice Address - Zip Code:01748-1672
Practice Address - Country:US
Practice Address - Phone:508-435-0222
Practice Address - Fax:508-435-6709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1902261Medicaid