Provider Demographics
NPI:1760601983
Name:CENTRE STREET REHABIILITATION, INC.
Entity Type:Organization
Organization Name:CENTRE STREET REHABIILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY AND TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-522-8500
Mailing Address - Street 1:488 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2057
Mailing Address - Country:US
Mailing Address - Phone:617-522-8500
Mailing Address - Fax:
Practice Address - Street 1:488 CENTRE ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2057
Practice Address - Country:US
Practice Address - Phone:617-522-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA187261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation