NPI 1699957415 · live from the CMS NPI Registry
464 Main Street Operations LLC
Skilled Nursing Facility in Agawam, MA. National Provider Identifier 1699957415, active.
NPI record
| NPI | 1699957415 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Skilled Nursing Facility 314000000X |
| Practice location | 464 Main St, Agawam, MA 01001 |
| Practice phone | 412-786-8000 |
| Mailing address | 101 E State St, Kennett Square, PA 19348 |
| Enumerated | December 4, 2007 |
| Last updated | October 23, 2020 |
| Authorized official | Michael Berg, Asst Secretary |
| Other names | Memory Support Of Heritage Hall |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Skilled Nursing Facility primary | 314000000X | 0875 (MA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.