Provider Demographics
NPI:1598755027
Name:JEWISH HEALTHCARE CENTER, INC
Entity Type:Organization
Organization Name:JEWISH HEALTHCARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-798-8653
Mailing Address - Street 1:629 SALISBURY ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1120
Mailing Address - Country:US
Mailing Address - Phone:508-798-8653
Mailing Address - Fax:508-791-1647
Practice Address - Street 1:629 SALISBURY ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1120
Practice Address - Country:US
Practice Address - Phone:508-798-8653
Practice Address - Fax:508-791-1647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0826314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0912557Medicaid
MA0912557Medicaid