Provider Demographics
NPI:1659447019
Name:BERKSHIRE EXTENDED CARE SERVICES INC
Entity Type:Organization
Organization Name:BERKSHIRE EXTENDED CARE SERVICES INC
Other - Org Name:KIMBALL FARMS NURSING CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:JONES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:413-447-2996
Mailing Address - Street 1:40 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:MA
Mailing Address - Zip Code:01240-2018
Mailing Address - Country:US
Mailing Address - Phone:413-637-5011
Mailing Address - Fax:413-637-0849
Practice Address - Street 1:40 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:01240-2018
Practice Address - Country:US
Practice Address - Phone:413-637-5011
Practice Address - Fax:413-637-0849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0CUS314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0926256Medicaid
225764Medicare Oscar/Certification
MA0926256Medicaid