Provider Demographics
NPI:1730176561
Name:SEASHORE POINT-DEACONESS, INC.
Entity type:Organization
Organization Name:SEASHORE POINT-DEACONESS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:HERB
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-369-5151
Mailing Address - Street 1:80 DEACONESS ROAD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742
Mailing Address - Country:US
Mailing Address - Phone:978-369-5151
Mailing Address - Fax:978-371-1755
Practice Address - Street 1:100 ALDEN ST
Practice Address - Street 2:
Practice Address - City:PROVINCETOWN
Practice Address - State:MA
Practice Address - Zip Code:02657
Practice Address - Country:US
Practice Address - Phone:508-487-7090
Practice Address - Fax:508-487-2967
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEASHORE POINT-DEACONESS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-06
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0849314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0940003Medicaid
225637Medicare Oscar/Certification
MA22-5637Medicare ID - Type Unspecified
MA0940003Medicaid