Organization
BURGOYNE REST HOME INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLARD L L BASLER ADM (ADMINISTRATOR)
(617) 445-1868
Entity
Organization
Contact information
Practice address
53 HARTFORD ST, DORCHESTER, MA 02125-2829
(617) 445-1868
(617) 445-2066
Mailing address
53 HARTFORD ST, DORCHESTER, MA 02125-2829
(617) 445-1868
(617) 445-2066
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
1027
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5508347
—
MA
Enumeration date
08/05/2007
Last updated
08/05/2007
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