Provider Demographics
NPI:1982711917
Name:BRAINTREE NURSING, L.L.C.
Entity Type:Organization
Organization Name:BRAINTREE NURSING, L.L.C.
Other - Org Name:KINDRED NURSING AND REHABILITATION - BRAINTREE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-596-7563
Mailing Address - Street 1:680 S 4TH ST # KH-2
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2407
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1102 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-5438
Practice Address - Country:US
Practice Address - Phone:781-848-3100
Practice Address - Fax:781-848-6487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0710314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0021901OtherMARTINS POINT
MA0925331Medicaid
MA1191880OtherUNITED HEALTH CARE
MA2222544501OtherBLUE CROSS BLUE SHIELD
MA907781OtherEVERCARE
MA71-00049OtherCIGNA
MA000000020298OtherBMC HEALTH NET
MA0021901OtherMARTINS POINT