Provider Demographics
NPI:1134292741
Name:COMMONWEALTH COMMUNITIES HOME HEALTH CARE AGENCY
Entity Type:Organization
Organization Name:COMMONWEALTH COMMUNITIES HOME HEALTH CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSHINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-297-8662
Mailing Address - Street 1:50 KERRY PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-4775
Mailing Address - Country:US
Mailing Address - Phone:781-297-8626
Mailing Address - Fax:781-297-8379
Practice Address - Street 1:50 KERRY PL
Practice Address - Street 2:SUITE 100
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-4775
Practice Address - Country:US
Practice Address - Phone:781-297-8626
Practice Address - Fax:781-297-8379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0600776Medicaid
MA0600776Medicaid