Provider Demographics
NPI:1336678630
Name:40 MARTIN STREET OPERATOR LLC
Entity Type:Organization
Organization Name:40 MARTIN STREET OPERATOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:STEPHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-943-7747
Mailing Address - Street 1:75 2ND AVE STE 605
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-2863
Mailing Address - Country:US
Mailing Address - Phone:617-943-7747
Mailing Address - Fax:617-454-1051
Practice Address - Street 1:40 MARTIN ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3607
Practice Address - Country:US
Practice Address - Phone:781-665-7050
Practice Address - Fax:781-665-8209
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEXT STEP HEALTHCARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility