Provider Demographics
NPI:1790771426
Name:FAMILY REHABILITATION SERVICES, INC.
Entity Type:Organization
Organization Name:FAMILY REHABILITATION SERVICES, INC.
Other - Org Name:HANCOCK SKILLED NURSING AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOUGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-265-5221
Mailing Address - Street 1:133 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-2136
Mailing Address - Country:US
Mailing Address - Phone:617-265-5221
Mailing Address - Fax:
Practice Address - Street 1:133 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02125-2136
Practice Address - Country:US
Practice Address - Phone:617-265-5221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0465314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0920401Medicaid
MA225628Medicare Oscar/Certification