Provider Demographics
NPI:1992793509
Name:CLIFTON GERIATRIC CENTER
Entity type:Organization
Organization Name:CLIFTON GERIATRIC CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-675-7589
Mailing Address - Street 1:500 WILBUR AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02725-2051
Mailing Address - Country:US
Mailing Address - Phone:508-675-7589
Mailing Address - Fax:508-672-7422
Practice Address - Street 1:500 WILBUR AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:MA
Practice Address - Zip Code:02725-2051
Practice Address - Country:US
Practice Address - Phone:508-675-7589
Practice Address - Fax:508-672-7422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0854314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0928861Medicaid
MA9711716Medicaid
MA0928861Medicaid