464 Main Street Operations LLC
NPI #1699957415 in Agawam, Massachusetts
Provider Information
- NPI Number
- 1699957415
- Entity Type
- Organization
- Organization Name
- 464 Main Street Operations LLC
- Primary Specialty
- Skilled Nursing Facility
- Enumeration Date
- Dec 4, 2007
- Last Updated
- Oct 23, 2020
Practice Location
- Address
- 464 MAIN ST
- City
- Agawam
- State
- Massachusetts
- ZIP Code
- 01001-1826
- Phone
- (412) 786-8000
Authorized Official
- Name
- MICHAEL T BERG
- Title
- ASST SECRETARY
- Phone
- (505) 468-4742
Specialties & Taxonomy Codes
| Specialty |
|---|
| Skilled Nursing Facility |
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