Provider Demographics
NPI:1194146704
Name:SOUTH COVE MANOR NURSING AND REHABILITATION CENTER, INC.
Entity type:Organization
Organization Name:SOUTH COVE MANOR NURSING AND REHABILITATION CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-423-0590
Mailing Address - Street 1:288 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5523
Mailing Address - Country:US
Mailing Address - Phone:617-423-0590
Mailing Address - Fax:617-292-7922
Practice Address - Street 1:288 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5523
Practice Address - Country:US
Practice Address - Phone:617-423-0590
Practice Address - Fax:617-292-7922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-27
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA225514Medicare Oscar/Certification