Provider Demographics
NPI:1255404448
Name:WILLIAM B RICE EVENTIDE HOME
Entity type:Organization
Organization Name:WILLIAM B RICE EVENTIDE HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAGLUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-660-5010
Mailing Address - Street 1:25 STONEHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-3926
Mailing Address - Country:US
Mailing Address - Phone:781-660-5000
Mailing Address - Fax:781-660-5001
Practice Address - Street 1:25 STONEHAVEN DR
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-3926
Practice Address - Country:US
Practice Address - Phone:781-660-5000
Practice Address - Fax:781-660-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0437314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110025833AMedicaid
MA225739Medicare Oscar/Certification