Provider Demographics
NPI:1942296793
Name:MOUNT PLEASANT HOME
Entity Type:Organization
Organization Name:MOUNT PLEASANT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MERLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUTHWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-522-7600
Mailing Address - Street 1:301 S HUNTINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4807
Mailing Address - Country:US
Mailing Address - Phone:617-522-7600
Mailing Address - Fax:617-522-0201
Practice Address - Street 1:301 S HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-4807
Practice Address - Country:US
Practice Address - Phone:617-522-7600
Practice Address - Fax:617-522-0201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1096 (DEPT PUB HLTH)311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5500923Medicaid