Provider Demographics
NPI:1184701963
Name:QUEEN ANNE NURSING HOME, INC.
Entity type:Organization
Organization Name:QUEEN ANNE NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:STARR
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:781-749-4982
Mailing Address - Street 1:50 RECREATION PARK DR
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4206
Mailing Address - Country:US
Mailing Address - Phone:781-749-4982
Mailing Address - Fax:781-740-4283
Practice Address - Street 1:50 RECREATION PARK DR
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4206
Practice Address - Country:US
Practice Address - Phone:781-749-4982
Practice Address - Fax:781-740-4283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0834314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0917605Medicaid
MA225254Medicare Oscar/Certification