Provider Demographics
NPI:1356338602
Name:BEDFORD VILLAGE NURSING HOME, INC.
Entity type:Organization
Organization Name:BEDFORD VILLAGE NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-990-1133
Mailing Address - Street 1:PO BOX 4024
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02741-4024
Mailing Address - Country:US
Mailing Address - Phone:508-990-1133
Mailing Address - Fax:508-990-2379
Practice Address - Street 1:9 POPE ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-5425
Practice Address - Country:US
Practice Address - Phone:508-990-1133
Practice Address - Fax:508-990-2379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0915521Medicaid
MA225599Medicare ID - Type Unspecified