Provider Demographics
NPI:1902983240
Name:SEACOAST NURSING AND REHABILITATION CENTER, INC.
Entity Type:Organization
Organization Name:SEACOAST NURSING AND REHABILITATION CENTER, INC.
Other - Org Name:SEACOAST NURSING AND REHABILITATION CENTER
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:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-596-7563
Mailing Address - Street 1:292 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-4832
Mailing Address - Country:US
Mailing Address - Phone:978-283-0300
Mailing Address - Fax:978-281-6774
Practice Address - Street 1:292 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-4832
Practice Address - Country:US
Practice Address - Phone:978-283-0300
Practice Address - Fax:978-281-6774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0946314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5933052OtherAETNA
MA0920851Medicaid
MA2222556701OtherBLUE CROSS BLUE SHIELD
MA728244OtherTUFTS
MA1119608OtherUNITED HEALTHCARE
MA1119608OtherUNITED HEALTHCARE