Provider Demographics
NPI:1912992918
Name:GERIATRIC FACILITIES OF CAPE COD, INC.
Entity Type:Organization
Organization Name:GERIATRIC FACILITIES OF CAPE COD, INC.
Other - Org Name:PLEASANT BAY NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ZUCKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-240-3500
Mailing Address - Street 1:383 S ORLEANS RD
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631-2870
Mailing Address - Country:US
Mailing Address - Phone:508-240-3500
Mailing Address - Fax:508-240-1969
Practice Address - Street 1:383 S ORLEANS RD
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:MA
Practice Address - Zip Code:02631-2870
Practice Address - Country:US
Practice Address - Phone:508-240-3500
Practice Address - Fax:508-240-1969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0984314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0926141Medicaid
MA2222566701OtherBLUE CROSS BLUE SHIELD
MA699058OtherTUFTS HEALTH PLAN
MA2222566701OtherBLUE CROSS BLUE SHIELD