Provider Demographics
NPI:1629164975
Name:METRO HEALTH FOUNDATION OF MASSACHUSETTS, INC.
Entity Type:Organization
Organization Name:METRO HEALTH FOUNDATION OF MASSACHUSETTS, INC.
Other - Org Name:BOSTONIAN SKILLED NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:LIMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-803-7361
Mailing Address - Street 1:337 NEPONSET AVE
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-3103
Mailing Address - Country:US
Mailing Address - Phone:617-265-2350
Mailing Address - Fax:617-265-0577
Practice Address - Street 1:337 NEPONSET AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-3103
Practice Address - Country:US
Practice Address - Phone:617-265-2350
Practice Address - Fax:617-265-0577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0794314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA734288OtherTUFTS INSURANCE
MA0929280Medicaid
MA110026525DMedicaid
MA905012OtherHARVARD PILGRIM INSURANCE
MA2222543601OtherBLUE CROSS BLUE SHIELD IN
MA734288OtherTUFTS INSURANCE