Provider Demographics
NPI:1033199476
Name:SOMERVILLE HOME, INC.
Entity Type:Organization
Organization Name:SOMERVILLE HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALYSON
Authorized Official - Middle Name:L
Authorized Official - Last Name:TOOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-776-0260
Mailing Address - Street 1:117 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-2706
Mailing Address - Country:US
Mailing Address - Phone:617-776-0260
Mailing Address - Fax:617-628-9721
Practice Address - Street 1:117 SUMMER ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-2706
Practice Address - Country:US
Practice Address - Phone:617-776-0260
Practice Address - Fax:617-628-9721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1375313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5503272Medicaid