Provider Demographics
NPI:1053533224
Name:TEWKSBURY ASSISTED LIVING, LLC
Entity type:Organization
Organization Name:TEWKSBURY ASSISTED LIVING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GUAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-429-0142
Mailing Address - Street 1:3131 ELLIOTT AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-1044
Mailing Address - Country:US
Mailing Address - Phone:206-298-2909
Mailing Address - Fax:206-301-4500
Practice Address - Street 1:2000 EMERALD CT
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-5220
Practice Address - Country:US
Practice Address - Phone:978-640-0194
Practice Address - Fax:978-640-0279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility