Mohawk Manor Rest Home, Inc

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

1290 Issued in MA

Legal business name

MOHAWK MANOR REST HOME, INC

Practice address

45 Water St
Shelburne Falls, MA 01370-1126

Phone

(413) 625-6860

Fax

(413) 625-6136

NPI assigned

May 11, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stacy Bissell

Title

President

Phone

(413) 625-6860

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mohawk Manor Rest Home Other name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1205041522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 WATER ST",
            "city": "SHELBURNE FALLS",
            "state": "MA",
            "postal_code": "013701126",
            "telephone_number": "413-625-6860",
            "fax_number": "413-625-6136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 WATER ST",
            "city": "SHELBURNE FALLS",
            "state": "MA",
            "postal_code": "013701126",
            "telephone_number": "413-625-6860",
            "fax_number": "413-625-6136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOHAWK MANOR REST HOME, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BISSELL",
        "authorized_official_first_name": "STACY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "413-625-6860"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "MA",
            "license": "1290",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5500907",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mohawk Manor Rest Home",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Morghan McCarthy, C.O.T.A/L
• Jaclyn Mickiewicz, LICSW
• Robert James Miller, MD
• Barbara Jeanne Miner, R.D.O.
• Thomas Joseph Miner, RDO
• Mohawk Trail Regional School District
• My Guardian Angel PRS, LLC.
• National Birth Centers, Inc.
• Elizabeth Nelson, RBT
• Gordon B Parker, ED.D

• Adult Care Home Facility in Shelburne Falls, MA
• Providers in Shelburne Falls, MA by specialty
• Adult Care Home Facility in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.