Provider Demographics
NPI:1457348500
Name:COLONIAL HEALTH GROUP-WESTRIDGE, LLC
Entity Type:Organization
Organization Name:COLONIAL HEALTH GROUP-WESTRIDGE, LLC
Other - Org Name:MARLBOROUGH HILLS HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-420-1500
Mailing Address - Street 1:121 NORTHBORO RD E
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-1844
Mailing Address - Country:US
Mailing Address - Phone:508-485-4040
Mailing Address - Fax:508-481-5585
Practice Address - Street 1:121 NORTHBORO RD E
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-1844
Practice Address - Country:US
Practice Address - Phone:508-485-4040
Practice Address - Fax:508-481-5585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0376314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0928976Medicaid
MA0928976Medicaid