WV-Brockton SNF, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0695 Issued in MA

Legal business name

WV-BROCKTON SNF, LLC

Practice address

2 Beaumont Ave
Brockton, MA 02302-3302

Phone

(508) 559-2521

NPI assigned

Sep 26, 2016

Organization subpart

Yes

Parent organization

WACHUSETT VENTURES, LLCAs reported in NPPES

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

Authorized official

Name

Mr. Raymond A. Dennehy III

Title

Principal

Phone

(978) 886-3336

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Brockton Health Center Doing business as

Part of

Wachusett Ventures LLC

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Wachusett Ventures LLC

  • Skilled Nursing Facility
  • Wellesley Hills, MA
  • NPI 1083065908
  NPPES parent name

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

{
    "created_epoch": "1474848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474848000000",
    "number": "1922557487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36 WASHINGTON ST",
            "address_2": "SUITE 190",
            "city": "WELLESLEY HILLS",
            "state": "MA",
            "postal_code": "024811900",
            "telephone_number": "978-886-3336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 BEAUMONT AVE",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023023302",
            "telephone_number": "508-559-2521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WV-BROCKTON SNF, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WACHUSETT VENTURES, LLC",
        "enumeration_date": "2016-09-26",
        "last_updated": "2016-09-26",
        "status": "A",
        "authorized_official_last_name": "DENNEHY",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRINCIPAL",
        "authorized_official_telephone_number": "978-886-3336",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MA",
            "license": "0695",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11010204A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brockton Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brianna Joycelyn Wright, MD
• Kristina Sue Wright, PHARMD
• Maurica Sherrard Wright, RD
• Robert F Wright Jr., MD
• Ian Michael Wu, M.D.
• Kristina L Wyman
• Brianna Nicole Wyrosdic
• Ilyas Yambayev, M.D.
• Kamylla Yancey
• Bryan Curtis Yanez, MD, MBA

• Skilled Nursing Facility in Brockton, MA
• Providers in Brockton, MA by specialty
• Skilled Nursing Facility in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2016; 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.