Organization
MT IDA REST HOME, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. INDIRA DESAI D, SC. (PRESIDENT)
(508) 665-6050
Entity
Organization
Contact information
Practice address
32 NEWTONVILLE AVE, NEWTONVILLE, MA 02458-1939
(508) 665-6050
(508) 875-8872
Mailing address
PO BOX 24, NEWTONVILLE, MA 02460-0001
(508) 665-6050
(508) 875-8872
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
872
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5507723
—
MA
Enumeration date
03/06/2007
Last updated
06/24/2008
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