Provider Demographics
NPI:1114166188
Name:OOSTERMAN REST HOME INC.
Entity Type:Organization
Organization Name:OOSTERMAN REST HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:OOSTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-665-3188
Mailing Address - Street 1:93 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-4044
Mailing Address - Country:US
Mailing Address - Phone:781-665-3188
Mailing Address - Fax:781-665-2295
Practice Address - Street 1:93 LAUREL ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-4044
Practice Address - Country:US
Practice Address - Phone:781-665-3188
Practice Address - Fax:781-665-2295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA725311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility