NPIMap

Organization Active NPI

Medway Country Manor, Inc.

Doing business as Generations Outpatient Wellness & Rehabilitation Center

  • Physical Therapist
  • Medway, MA
National Provider Identifier
1205854981
Registry record updated Nov 30, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
0840 Issued in MA
Legal business name
MEDWAY COUNTRY MANOR, INC.
Doing business as
Generations Outpatient Wellness & Rehabilitation Center
Practice address
115 Holliston St
Medway, MA 02053-1954
Phone
(508) 533-9893
Fax
(508) 533-7048
NPI assigned
Jul 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2007

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

Authorized official

Name
Mr. John Peters III
Title
Treasurer
Phone
(508) 533-6634

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 0840 MA Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X 0840 MA
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X 0840 MA

Addresses

Primary practice location

115 Holliston St
Medway, MA 02053-1954

Mailing address

115 Holliston St
Medway, MA 02053-1954
Phone (508) 533-9893

Other identifiers 4

IdentifierTypeStateIssuer
0910481MedicaidMA
Y61422OtherBLUE CROSS BLUE SHIELD
SG0026OtherBLUE CROSS BLUE SHIELD
OG0035OtherBLUE CROSS BLUE SHIELD

Other names 1

  • Generations Outpatient Wellness & Rehabilitation Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Medway Country Manor4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

115 Holliston St
Medway, MA 02053
Phone (508) 533-6634

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196380800000",
    "number": "1205854981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 HOLLISTON ST",
            "city": "MEDWAY",
            "state": "MA",
            "postal_code": "020531954",
            "telephone_number": "508-533-9893",
            "fax_number": "508-533-7048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 HOLLISTON ST",
            "city": "MEDWAY",
            "state": "MA",
            "postal_code": "020531954",
            "telephone_number": "508-533-9893",
            "fax_number": "508-533-7048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDWAY COUNTRY MANOR, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-18",
        "last_updated": "2007-11-30",
        "status": "A",
        "authorized_official_last_name": "PETERS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "508-533-6634",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "0840",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "MA",
            "license": "0840",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "MA",
            "license": "0840",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0910481",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "Y61422",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "SG0026",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "OG0035",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Generations Outpatient Wellness & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Medway, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2007; 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.