Provider Demographics
NPI:1437288701
Name:JAMES MANOR REST HOME
Entity Type:Organization
Organization Name:JAMES MANOR REST HOME
Other - Org Name:JENMAR CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:ADM OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:GERRY
Authorized Official - Last Name:DESMARAIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-343-7400
Mailing Address - Street 1:PO BOX 2185
Mailing Address - Street 2:222 SOUTH ST
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420
Mailing Address - Country:US
Mailing Address - Phone:978-343-7400
Mailing Address - Fax:978-343-7775
Practice Address - Street 1:222 SOUTH ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420
Practice Address - Country:US
Practice Address - Phone:978-343-7400
Practice Address - Fax:978-343-7775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1350RESTHOME311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA55508592OtherMASS PROVIDER