NPI 1558890939 · live from the CMS NPI Registry
120 Main Street Operator LLC
Skilled Nursing Facility in Malden, MA. National Provider Identifier 1558890939, active.
NPI record
| NPI | 1558890939 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Skilled Nursing Facility 314000000X |
| Practice location | 120 Main St, Malden, MA 02148 |
| Practice phone | 781-324-5600 |
| Mailing address | 75 2nd Ave Ste 605, Needham, MA 02494 |
| Enumerated | June 8, 2017 |
| Last updated | June 8, 2017 |
| Authorized official | William Stephan, Chief Financial Officer |
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.