NPIMap

Organization Active NPI

Sudbury Pines Extended Care Facility

  • Skilled Nursing Facility
  • Sudbury, MA
National Provider Identifier
1215924147
Registry record updated Mar 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0382 Issued in MA
Legal business name
SUDBURY PINES EXTENDED CARE FACILITY
Practice address
642 Boston Post Rd
Sudbury, MA 01776-3302
Phone
(978) 443-9000
Fax
(978) 443-9510
NPI assigned
Oct 5, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2012

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

Authorized official

Name
Ms. Roberta C Henderson, NHA
Title
Administrator
Phone
(978) 443-9000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0382 MA Primary

Addresses

Primary practice location

642 Boston Post Rd
Sudbury, MA 01776-3302

Mailing address

642 Boston Post Rd
Sudbury, MA 01776-3302
Phone (978) 443-9000

Other identifiers 2

IdentifierTypeStateIssuer
225531OtherMAOSCAR CERTIFICATION
0926248MedicaidMA

Other names 1

  • Sudbury Pines Extended Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20051014000141 MA Part B Supplier - Clinic/Group Practice 7810912284 Receives reassigned benefits from 1 practitioner
Practice locations: Sudbury, MA
O20120202000217 MA Part A Provider - Skilled Nursing Facility 7810912284 Practice locations: Sudbury, MA

Skilled nursing facility certification: CCN 225531

Legal name
SUDBURY PINES EXTENDED CARE FACILITY
Doing business as
SUDBURY PINES EXTENDED CARE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 8, 1991
Last certification
Mar 6, 2025
Beds
92
Ownership / control type
Corporation
Organization structure
CorporationProprietary
Enrollment address
642 Boston Post Rd
Sudbury, MA 01776-3512
Nursing home name
SUDBURY PINES EXTENDED CARE

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Sudbury Pines Extended CareCCN 225531
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
4 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jan 8, 1991
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9285.6 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Roberta C Henderson Individual 5% Or Greater Direct Ownership InterestPresident Jan 26, 2012 100%
Corporate OfficerPresident Mar 31, 2001
Operational/Managerial Control Jan 1, 1983
Adp of the SNF Jan 1, 1983
Sandeep Jain Individual Operational/Managerial Control Jun 29, 2014
Adp of the SNF Jun 29, 2014
Sudbury Pines Extended Care Facility Organization, Sudbury, MA Corporation Adp of the SNF Jul 17, 2025

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332892800000",
    "number": "1215924147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "642 BOSTON POST RD",
            "city": "SUDBURY",
            "state": "MA",
            "postal_code": "017763302",
            "telephone_number": "978-443-9000",
            "fax_number": "978-443-9510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "642 BOSTON POST RD",
            "city": "SUDBURY",
            "state": "MA",
            "postal_code": "017763302",
            "telephone_number": "978-443-9000",
            "fax_number": "978-443-9510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUDBURY PINES EXTENDED CARE FACILITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-05",
        "last_updated": "2012-03-28",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "ROBERTA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "978-443-9000",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "NHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MA",
            "license": "0382",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OSCAR CERTIFICATION",
            "identifier": "225531",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0926248",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sudbury Pines Extended Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sudbury, MA

Sources for this page

Verify at the official NPI Registry.