Provider Demographics
NPI:1043656630
Name:WG FALMOUTH SH II, LLC
Entity type:Organization
Organization Name:WG FALMOUTH SH II, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:W
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-779-4700
Mailing Address - Street 1:401 S 4TH ST STE 1900
Mailing Address - Street 2:ATTN: LEGAL DEPT.
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-4436
Mailing Address - Country:US
Mailing Address - Phone:502-779-4700
Mailing Address - Fax:502-779-4749
Practice Address - Street 1:389 GIFFORD ST
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540
Practice Address - Country:US
Practice Address - Phone:508-495-5500
Practice Address - Fax:508-495-9515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAPPLIED FOR310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility