Provider Demographics
NPI:1679569487
Name:WAREHAM HEALTH GROUP LLC
Entity type:Organization
Organization Name:WAREHAM HEALTH GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-441-5082
Mailing Address - Street 1:605 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-1031
Mailing Address - Country:US
Mailing Address - Phone:508-295-1040
Mailing Address - Fax:508-291-1904
Practice Address - Street 1:605 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-1031
Practice Address - Country:US
Practice Address - Phone:508-295-1040
Practice Address - Fax:508-291-1904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0671314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0928399Medicaid
MA225488Medicare ID - Type UnspecifiedMEDICARE MUTUAL OF OMAHA