Provider Demographics
NPI:1932195625
Name:MEDFORD HEALTH GROUP LLC
Entity Type:Organization
Organization Name:MEDFORD HEALTH GROUP LLC
Other - Org Name:STONEHEDGE REHAB & SKILLED CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:671-327-6325
Mailing Address - Street 1:5 REDLANDS RD
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-1506
Mailing Address - Country:US
Mailing Address - Phone:617-327-6325
Mailing Address - Fax:617-327-8204
Practice Address - Street 1:5 REDLANDS RD
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-1506
Practice Address - Country:US
Practice Address - Phone:617-327-6325
Practice Address - Fax:617-327-8204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0534314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0929255Medicaid
MA225429Medicare ID - Type UnspecifiedMEDICARE MUTUAL OF OMAHA