Provider Demographics
NPI:1386634020
Name:ADMIRAL'S HILL ASSISTED LIVING II, LLC
Entity Type:Organization
Organization Name:ADMIRAL'S HILL ASSISTED LIVING II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-889-6766
Mailing Address - Street 1:17 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-2010
Mailing Address - Country:US
Mailing Address - Phone:617-884-6766
Mailing Address - Fax:617-889-6176
Practice Address - Street 1:175 CAPTAINS ROW
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-4079
Practice Address - Country:US
Practice Address - Phone:617-889-8740
Practice Address - Fax:617-887-0135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1902873Medicaid