Provider Demographics
NPI:1730287632
Name:JEWISH REHABILITATION CENTER FOR AGED OF THE NORTH SHORE, INC.
Entity Type:Organization
Organization Name:JEWISH REHABILITATION CENTER FOR AGED OF THE NORTH SHORE, INC.
Other - Org Name:JEFFREY & SUSAN BRUDNICK CENTER FOR LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:LANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-471-5100
Mailing Address - Street 1:240 LYNNFIELD ST
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-5055
Mailing Address - Country:US
Mailing Address - Phone:978-471-5100
Mailing Address - Fax:978-471-5508
Practice Address - Street 1:240 LYNNFIELD ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-5055
Practice Address - Country:US
Practice Address - Phone:978-471-5100
Practice Address - Fax:978-471-5508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2017-03-01
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
MA0903485Medicaid
MA225472Medicare Oscar/Certification