NPI 1053178582 · live from the CMS NPI Registry
200 Governors Opco LLC
Skilled Nursing Facility in Medford, MA. National Provider Identifier 1053178582, active.
NPI record
| NPI | 1053178582 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Skilled Nursing Facility 314000000X |
| Practice location | 200 Governors Ave, Medford, MA 02155 |
| Practice phone | 781-391-5400 |
| Enumerated | March 1, 2024 |
| Last updated | March 1, 2024 |
| Authorized official | Eliyahu Mirlis, Owner |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Skilled Nursing Facility primary | 314000000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.