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Organization
MEDWAY COUNTRY MANOR, INC.
Active
Organization
MEDWAY COUNTRY MANOR, INC.
Active
Other names
Generations Outpatient Wellness & Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN PETERS III (TREASURER)
(508) 533-6634
Entity
Organization
Contact information
Practice address
115 HOLLISTON ST, MEDWAY, MA 02053-1954
(508) 533-9893
(508) 533-7048
Mailing address
115 HOLLISTON ST, MEDWAY, MA 02053-1954
(508) 533-9893
(508) 533-7048
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0840
MA
225X00000X
Occupational Therapist
0840
MA
235Z00000X
Speech-Language Pathologist
0840
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0910481
—
MA
01
—
OG0035
BLUE CROSS BLUE SHIELD
—
01
—
SG0026
BLUE CROSS BLUE SHIELD
—
01
—
Y61422
BLUE CROSS BLUE SHIELD
—
Enumeration date
07/18/2006
Last updated
11/30/2007
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