Organization
464 MAIN STREET OPERATIONS LLC
Active
Other names
MEMORY SUPPORT OF HERITAGE HALL
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL T BERG (ASST SECRETARY)
(505) 468-4742
Entity
Organization
Contact information
Practice address
464 MAIN ST, AGAWAM, MA 01001-1826
(412) 786-8000
(413) 789-1099
Mailing address
101 E STATE ST, KENNETT SQUARE, PA 19348-3109
(610) 925-4436
(610) 925-4351
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0875
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110088864A
—
MA
Enumeration date
12/04/2007
Last updated
10/23/2020
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