Provider Demographics
NPI:1407990518
Name:SCANDINAVIAN CHARITABLE SOCIETY OF GREATER BOSTON
Entity Type:Organization
Organization Name:SCANDINAVIAN CHARITABLE SOCIETY OF GREATER BOSTON
Other - Org Name:SCANDINAVIAN LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CARELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:617-527-6566
Mailing Address - Street 1:206 WALTHAM ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-1733
Mailing Address - Country:US
Mailing Address - Phone:617-527-6566
Mailing Address - Fax:617-527-2078
Practice Address - Street 1:206 WALTHAM ST
Practice Address - Street 2:
Practice Address - City:WEST NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02465-1733
Practice Address - Country:US
Practice Address - Phone:617-527-6566
Practice Address - Fax:617-527-2078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1904531Medicaid