Provider Demographics
NPI:1952313322
Name:WETTERBERG NURSING HOMES, INC.
Entity Type:Organization
Organization Name:WETTERBERG NURSING HOMES, INC.
Other - Org Name:POND VIEW NURSING FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WETTERBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-277-2633
Mailing Address - Street 1:81 S HUNTINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4704
Mailing Address - Country:US
Mailing Address - Phone:617-277-2633
Mailing Address - Fax:617-277-1866
Practice Address - Street 1:81 S HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-4704
Practice Address - Country:US
Practice Address - Phone:617-277-2633
Practice Address - Fax:617-277-1866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0538314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0919608Medicaid
MA225675Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER