Provider Demographics
NPI:1952300543
Name:ST. CAMILLUS HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:ST. CAMILLUS HEALTH CENTER, INC.
Other - Org Name:ST. CAMILLUS NURSING HOME
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-234-7306
Mailing Address - Street 1:447 HILL ST
Mailing Address - Street 2:
Mailing Address - City:WHITINSVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01588-1016
Mailing Address - Country:US
Mailing Address - Phone:508-234-7306
Mailing Address - Fax:508-234-7597
Practice Address - Street 1:447 HILL ST
Practice Address - Street 2:
Practice Address - City:WHITINSVILLE
Practice Address - State:MA
Practice Address - Zip Code:01588-1016
Practice Address - Country:US
Practice Address - Phone:508-234-7306
Practice Address - Fax:508-234-7597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0896314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA09-27121Medicaid
MA38OtherFALLON COMMUNITY HEALTHCA
MA2222531201OtherBC BS OF MA
MA2222531201OtherBC BS OF MA
MA38OtherFALLON COMMUNITY HEALTHCA