NPIMap

Organization Active NPI

Medway Country Manor, Inc.

  • Speech-Language Pathologist
  • Medway, MA
National Provider Identifier
1245403963
Registry record updated Apr 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
0840 Issued in MA
Legal business name
MEDWAY COUNTRY MANOR, INC.
Practice address
115 Holliston St
Medway, MA 02053-1954
Phone
(508) 533-9893
Fax
(508) 533-7048
NPI assigned
Apr 3, 2008
Organization subpart
Yes
Parent organization
MEDWAY COUNTRY MANOR, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 3, 2008

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X 0840 MA Primary

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 1

IdentifierTypeStateIssuer
0910481MedicaidMA

Other names 1

  • Generations Outpatient Wellness & Rehab - Speech Therapy Doing business as

National Provider Directory

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

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1207180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207180800000",
    "number": "1245403963",
    "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": "YES",
        "parent_organization_legal_business_name": "MEDWAY COUNTRY MANOR, INC.",
        "enumeration_date": "2008-04-03",
        "last_updated": "2008-04-03",
        "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": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "MA",
            "license": "0840",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0910481",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Generations Outpatient Wellness & Rehab - Speech Therapy",
            "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 Apr 3, 2008; 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.