Provider Demographics
NPI:1649266214
Name:QUABBIN VALLEY CONVALESCENT CENTER,INC.
Entity type:Organization
Organization Name:QUABBIN VALLEY CONVALESCENT CENTER,INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-249-3717
Mailing Address - Street 1:821 DANIEL SHAYS HWY
Mailing Address - Street 2:
Mailing Address - City:ATHOL
Mailing Address - State:MA
Mailing Address - Zip Code:01331-9609
Mailing Address - Country:US
Mailing Address - Phone:978-249-3717
Mailing Address - Fax:978-249-7700
Practice Address - Street 1:821 DANIEL SHAYS HWY
Practice Address - Street 2:
Practice Address - City:ATHOL
Practice Address - State:MA
Practice Address - Zip Code:01331-9609
Practice Address - Country:US
Practice Address - Phone:978-249-3717
Practice Address - Fax:978-249-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0071314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0915483Medicaid
MA225296Medicare Oscar/Certification