Provider Demographics
NPI:1679682934
Name:SANDISFIELD HEALTH GROUP, LLC
Entity Type:Organization
Organization Name:SANDISFIELD HEALTH GROUP, LLC
Other - Org Name:BERKSHIRE REHABILITATION AND SKILLED CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRODIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOZADJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-441-5082
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:SANDISFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01255-0216
Mailing Address - Country:US
Mailing Address - Phone:413-258-4731
Mailing Address - Fax:413-258-4116
Practice Address - Street 1:7 SANDISFIELD RD
Practice Address - Street 2:
Practice Address - City:SANDISFIELD
Practice Address - State:MA
Practice Address - Zip Code:01255-9621
Practice Address - Country:US
Practice Address - Phone:413-258-4731
Practice Address - Fax:413-258-4116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0940038Medicaid
MA0940038Medicaid