Provider Demographics
NPI:1720074669
Name:QUASIDE, INC
Entity Type:Organization
Organization Name:QUASIDE, INC
Other - Org Name:QUABOAG ON THE COMMON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SALVIETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-867-7716
Mailing Address - Street 1:47 E MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WEST BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01585-2906
Mailing Address - Country:US
Mailing Address - Phone:508-867-7716
Mailing Address - Fax:508-867-2074
Practice Address - Street 1:47 E MAIN STREET
Practice Address - Street 2:
Practice Address - City:WEST BROOKFIELD
Practice Address - State:MA
Practice Address - Zip Code:01585-2906
Practice Address - Country:US
Practice Address - Phone:508-867-7716
Practice Address - Fax:508-867-2074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0144314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0921378Medicaid
MA225361Medicare Oscar/Certification