Provider Demographics
NPI:1104812379
Name:SARAWOOD RETIREMENT HOME, INC.
Entity type:Organization
Organization Name:SARAWOOD RETIREMENT HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-532-7879
Mailing Address - Street 1:1 LOOMIS AVE
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-2011
Mailing Address - Country:US
Mailing Address - Phone:413-532-7879
Mailing Address - Fax:413-535-2015
Practice Address - Street 1:1 LOOMIS AVE
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-2011
Practice Address - Country:US
Practice Address - Phone:413-532-7879
Practice Address - Fax:413-535-2015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1905236261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1905236Medicaid