Provider Demographics
NPI:1831173400
Name:CLINTON MANOR NURSING HOME
Entity type:Organization
Organization Name:CLINTON MANOR NURSING HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-422-5111
Mailing Address - Street 1:18 DANA HILL RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:MA
Mailing Address - Zip Code:01564-2414
Mailing Address - Country:US
Mailing Address - Phone:978-422-5111
Mailing Address - Fax:978-422-5925
Practice Address - Street 1:18 DANA HILL RD
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:MA
Practice Address - Zip Code:01564-2414
Practice Address - Country:US
Practice Address - Phone:978-422-5111
Practice Address - Fax:978-422-5925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0082314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA696132OtherTUFTS
MA2222545201OtherBC BS MA
MA0913367Medicaid
MA225452Medicare ID - Type Unspecified