Provider Demographics
NPI:1639537756
Name:CHICOPEE GARDENS REHABILITATION AND CARE CENTER OPERATIONS LLC
Entity Type:Organization
Organization Name:CHICOPEE GARDENS REHABILITATION AND CARE CENTER OPERATIONS LLC
Other - Org Name:BIRCH GARDENS NURSING AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMZEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-505-0000
Mailing Address - Street 1:44 NEW LOMBARD RD
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-4857
Mailing Address - Country:US
Mailing Address - Phone:413-592-7738
Mailing Address - Fax:
Practice Address - Street 1:44 NEW LOMBARD RD
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-4857
Practice Address - Country:US
Practice Address - Phone:413-592-7738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-03
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0044314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA225539Medicare Oscar/Certification