Provider Demographics
NPI:1659366045
Name:CHS OF WALTHAM, INC.
Entity Type:Organization
Organization Name:CHS OF WALTHAM, INC.
Other - Org Name:MARISTHILL NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-893-0240
Mailing Address - Street 1:66 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-6058
Mailing Address - Country:US
Mailing Address - Phone:781-893-0240
Mailing Address - Fax:781-894-6330
Practice Address - Street 1:66 NEWTON ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-6058
Practice Address - Country:US
Practice Address - Phone:781-893-0240
Practice Address - Fax:781-894-6330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0727314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA225408Medicare Oscar/Certification