Provider Demographics
NPI:1962472274
Name:WEYMOUTH ASSISTED LIVING
Entity Type:Organization
Organization Name:WEYMOUTH ASSISTED LIVING
Other - Org Name:ALLERTON HOUSE AT CENTRAL PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:CASALE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:781-335-8666
Mailing Address - Street 1:43 SCHOOL HOUSE ROAD
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02188
Mailing Address - Country:US
Mailing Address - Phone:781-335-8666
Mailing Address - Fax:781-335-7666
Practice Address - Street 1:43 SCHOOL HOUSE RD
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02188-4142
Practice Address - Country:US
Practice Address - Phone:781-335-8666
Practice Address - Fax:781-335-7666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2020-08-22
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
MA1903918Medicaid