Provider Demographics
NPI:1447662234
Name:CORNERSTONE AT CANTON ASSISTED LIVING LLC
Entity type:Organization
Organization Name:CORNERSTONE AT CANTON ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TADD
Authorized Official - Middle Name:
Authorized Official - Last Name:CLELLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-268-9140
Mailing Address - Street 1:388 E 8TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-2957
Mailing Address - Country:US
Mailing Address - Phone:617-268-9140
Mailing Address - Fax:617-268-1380
Practice Address - Street 1:175 REVERE STREET
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021
Practice Address - Country:US
Practice Address - Phone:617-268-9140
Practice Address - Fax:617-268-1380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility