Provider Demographics
NPI:1528055696
Name:RADIUS MILLBURY OPERATING LLC
Entity type:Organization
Organization Name:RADIUS MILLBURY OPERATING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AR BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:ANDRUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-865-6106
Mailing Address - Street 1:29 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILLBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01527-2005
Mailing Address - Country:US
Mailing Address - Phone:508-865-6106
Mailing Address - Fax:508-865-7559
Practice Address - Street 1:29 MAIN ST
Practice Address - Street 2:
Practice Address - City:MILLBURY
Practice Address - State:MA
Practice Address - Zip Code:01527-2005
Practice Address - Country:US
Practice Address - Phone:508-865-6106
Practice Address - Fax:508-865-7559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0158314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0926710Medicaid
MA225308AMedicare ID - Type Unspecified