Provider Demographics
NPI:1013147685
Name:4499 ACUSHNET AVENUE OPERATING COMPANY, LLC
Entity Type:Organization
Organization Name:4499 ACUSHNET AVENUE OPERATING COMPANY, LLC
Other - Org Name:NEW BEDFORD REHABILITATION HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHEIF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-995-6900
Mailing Address - Street 1:4499 ACUSHNET AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02745-4707
Mailing Address - Country:US
Mailing Address - Phone:508-995-6900
Mailing Address - Fax:508-998-5974
Practice Address - Street 1:4499 ACUSHNET AVE
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-4707
Practice Address - Country:US
Practice Address - Phone:508-995-6900
Practice Address - Fax:508-998-5974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2224282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110027396CMedicaid