NPIMap

Organization Active NPI

South Cove Manor, Inc

  • Skilled Nursing Facility
  • Boston, MA
National Provider Identifier
1407859564
Registry record updated Apr 1, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0876 Issued in MA
Legal business name
SOUTH COVE MANOR, INC
Doing business as
South Cove Manor
Practice address
120 Shawmut Avenue
Boston, MA 02118-2293
Phone
(617) 423-0590
Fax
(617) 292-7922
NPI assigned
May 23, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2014

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

Authorized official

Name
Mr. Richard Wong
Title
President / Ceo
Phone
(617) 423-0590

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0876 MA Primary

Addresses

Primary practice location

120 Shawmut Avenue
Boston, MA 02118-2293

Mailing address

120 Shawmut Avenue
Boston, MA 02118-2293
Phone (617) 423-0590

Other identifiers 1

IdentifierTypeStateIssuer
0916056MedicaidMA

Other names 1

  • South Cove Manor Doing business as

National Provider Directory

National Provider Directory

Locations

120 Shawmut Ave
Boston, MA 02118
Phone (617) 423-0590

NPI Registry JSON

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396310400000",
    "number": "1407859564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 SHAWMUT AVENUE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182293",
            "telephone_number": "617-423-0590",
            "fax_number": "617-292-7922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 SHAWMUT AVENUE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182293",
            "telephone_number": "617-423-0590",
            "fax_number": "617-292-7922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH COVE MANOR, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-23",
        "last_updated": "2014-04-01",
        "status": "A",
        "authorized_official_last_name": "WONG",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT / CEO",
        "authorized_official_telephone_number": "617-423-0590",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MA",
            "license": "0876",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0916056",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Cove Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2014; 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.