Provider Demographics
NPI:1407082407
Name:NEWBRIDGE ON THE CHARLES, INC.
Entity Type:Organization
Organization Name:NEWBRIDGE ON THE CHARLES, INC.
Other - Org Name:NBOC RECUPERATIVE SERVICES UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-363-8211
Mailing Address - Street 1:7000 GREAT MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-4090
Mailing Address - Country:US
Mailing Address - Phone:781-234-9159
Mailing Address - Fax:
Practice Address - Street 1:7000 GREAT MEADOW RD
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-4090
Practice Address - Country:US
Practice Address - Phone:781-234-9159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-04
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMAOLMV314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA225774Medicare Oscar/Certification