1102 Washington Street Operator LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

1102 WASHINGTON STREET OPERATOR LLC

Doing business as

Braintree Manor HealthCare

Practice address

1102 Washington St
Braintree, MA 02184-5438

Phone

(781) 848-3100

NPI assigned

Aug 21, 2017

Last updated

Jul 21, 2022By 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

William H Stephan

Title

Cfo

Phone

(617) 943-7747

Specialties & licenses 1

Addresses

Other names 1

• Braintree Manor HealthCare Doing business as

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

{
    "created_epoch": "1503273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1902322092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1102 WASHINGTON ST",
            "city": "BRAINTREE",
            "state": "MA",
            "postal_code": "021845438",
            "telephone_number": "781-848-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 WASHINGTON ST",
            "city": "BRAINTREE",
            "state": "MA",
            "postal_code": "021845438",
            "telephone_number": "781-848-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1102 WASHINGTON STREET OPERATOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-21",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "STEPHAN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "617-943-7747"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Braintree Manor HealthCare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.