Provider Demographics
NPI:1972502813
Name:WABAN HEALTH & REHABILATION, INC.
Entity Type:Organization
Organization Name:WABAN HEALTH & REHABILATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DURSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-332-8481
Mailing Address - Street 1:20 KINMONTH RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02468-1503
Mailing Address - Country:US
Mailing Address - Phone:617-332-8481
Mailing Address - Fax:617-332-8959
Practice Address - Street 1:20 KINMONTH RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02468-1503
Practice Address - Country:US
Practice Address - Phone:617-332-8481
Practice Address - Fax:617-332-8959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0387314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA908337OtherHAVARD PILGRIM ID
MA0Q00490001OtherBC/BS, MEDEX PROVIDER ID
MA667864OtherTUFTS PROVIDER ID
MA0924512Medicaid
MA225553Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
MA667864OtherTUFTS PROVIDER ID