Provider Demographics
NPI:1508973041
Name:HEBREW SENIORLIFE HOSPICE CARE, INC.
Entity Type:Organization
Organization Name:HEBREW SENIORLIFE HOSPICE CARE, INC.
Other - Org Name:HEBREW SENIOR LIFE HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BANNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-234-9805
Mailing Address - Street 1:29 NEWBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026
Mailing Address - Country:US
Mailing Address - Phone:781-234-9900
Mailing Address - Fax:781-234-9869
Practice Address - Street 1:29 NEWBRIDGE WAY
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026
Practice Address - Country:US
Practice Address - Phone:781-234-9900
Practice Address - Fax:781-234-9869
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEBREW SENIORLIFE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-23
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA11088066AMedicaid
MA227422Medicare ID - Type Unspecified