Provider Demographics
NPI:1366591919
Name:SALEM COMMUNITY CORPORATION
Entity type:Organization
Organization Name:SALEM COMMUNITY CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:F
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-852-2670
Mailing Address - Street 1:87 BRIARWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-1225
Mailing Address - Country:US
Mailing Address - Phone:508-853-6910
Mailing Address - Fax:508-856-0112
Practice Address - Street 1:87 BRIARWOOD CIR
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-1225
Practice Address - Country:US
Practice Address - Phone:508-853-6910
Practice Address - Fax:508-856-0112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0119314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0920096Medicaid
MA0920096Medicaid