Provider Demographics
NPI:1124160619
Name:ST. JOSEPH'S ABBEY RESIDENT CARE FACILITY, INC.
Entity type:Organization
Organization Name:ST. JOSEPH'S ABBEY RESIDENT CARE FACILITY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ABBOT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:OCSO
Authorized Official - Phone:508-885-8700
Mailing Address - Street 1:167 N SPENCER RD
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:MA
Mailing Address - Zip Code:01562-1232
Mailing Address - Country:US
Mailing Address - Phone:508-885-8700
Mailing Address - Fax:508-885-8726
Practice Address - Street 1:167 N SPENCER RD
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:MA
Practice Address - Zip Code:01562-1232
Practice Address - Country:US
Practice Address - Phone:508-885-8700
Practice Address - Fax:508-885-8726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1DGQ320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5508711Medicaid