Provider Demographics
NPI:1053436154
Name:BEACON REHABILITATION & NURSING, LLC
Entity type:Organization
Organization Name:BEACON REHABILITATION & NURSING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-878-6700
Mailing Address - Street 1:52 ACCORD PARK DR
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1628
Mailing Address - Country:US
Mailing Address - Phone:781-878-6700
Mailing Address - Fax:781-878-9807
Practice Address - Street 1:170 CORY ROAD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-8244
Practice Address - Country:US
Practice Address - Phone:617-731-0515
Practice Address - Fax:617-731-0510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA02YF314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0927279Medicaid
MA982264OtherTUFTS HEALTH PLAN
MA909397OtherHARVARD PILGRIM
MA909397OtherHARVARD PILGRIM