Provider Demographics
NPI:1437155967
Name:HEBREW REHABILITATION CENTER
Entity Type:Organization
Organization Name:HEBREW REHABILITATION CENTER
Other - Org Name:HEBREW REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-363-8111
Mailing Address - Street 1:1200 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02131-1011
Mailing Address - Country:US
Mailing Address - Phone:617-325-8000
Mailing Address - Fax:617-363-8970
Practice Address - Street 1:1200 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02131-1011
Practice Address - Country:US
Practice Address - Phone:617-325-8000
Practice Address - Fax:617-363-8970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA 2290281P00000X
333600000X, 3336S0011X
MAMA01138193336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1209728Medicaid
2241204OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MA1100408Medicaid
MA1209728Medicaid