Provider Demographics
NPI:1972029098
Name:PHILLIPS MANOR LLC
Entity Type:Organization
Organization Name:PHILLIPS MANOR LLC
Other - Org Name:PHILLIPS MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:AUGERI
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:781-420-9245
Mailing Address - Street 1:18 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-4417
Mailing Address - Country:US
Mailing Address - Phone:781-420-9245
Mailing Address - Fax:
Practice Address - Street 1:28 LINWOOD RD
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01905-1638
Practice Address - Country:US
Practice Address - Phone:781-592-8000
Practice Address - Fax:781-598-1556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility