Organization
MEDWAY COUNTRY MANOR, INC.
Active
Other names
Medway Country Manor Skilled Nursing & Rehabilitation
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID SIMHA (PRESIDENT)
(917) 885-7050
Entity
Organization
Contact information
Practice address
115 HOLLISTON ST, MEDWAY, MA 02053-1954
(508) 533-6634
(508) 533-7048
Mailing address
115 HOLLISTON ST, MEDWAY, MA 02053-1954
(508) 533-6634
(508) 533-7048
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
0840
MA
225X00000X
Occupational Therapist
0840
MA
235Z00000X
Speech-Language Pathologist
0840
MA
314000000X
Skilled Nursing Facility
Primary
0840
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0461870001
NSC
MA
05
—
0910481
—
MA
01
—
2222541201
BLUE CROSS BLUE SHIELD
MA
01
—
OG0035
BLUE CROSS BLUE SHIELD
—
01
—
SG0026
BLUE CROSS BLUE SHIELD
—
01
—
Y61422
BLUE CROSS BLUE SHIELD
—
Enumeration date
05/24/2005
Last updated
07/30/2014
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