Organization
519 MAIN ST., INC.
Active
Other names
Thomas Upham House
Organization subpart
No
Provider details
NPI number
Authorized official
PETER H. THISSE (CONTROLLER)
(781) 762-0703
Entity
Organization
Contact information
Practice address
519 MAIN ST, MEDFIELD, MA 02052-2522
(508) 359-6050
(508) 359-7654
Mailing address
80 ACCESS RD, NORWOOD, MA 02062-5237
(781) 762-0703
(781) 762-2099
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0400
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0692760001
MEDICARE NSC
MA
05
—
0916986
—
MA
Enumeration date
12/13/2006
Last updated
12/16/2011
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