Provider Demographics
NPI:1770034944
Name:CHELSEA JEWISH COMMUNITY, INC.
Entity Type:Organization
Organization Name:CHELSEA JEWISH COMMUNITY, INC.
Other - Org Name:CHELSEA JEWISH HOSPICE AND PALLIATIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-471-5100
Mailing Address - Street 1:165 CAPTAINS ROW
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-4019
Mailing Address - Country:US
Mailing Address - Phone:617-887-0001
Mailing Address - Fax:
Practice Address - Street 1:123 CAPTAINS ROW
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-4019
Practice Address - Country:US
Practice Address - Phone:617-889-0811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHELSEA JEWISH LIFECARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-21
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7RKJ251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110024502BMedicaid
MA110024502BMedicaid