Provider Demographics
NPI:1811023013
Name:MELVILLE REST HOME
Entity Type:Organization
Organization Name:MELVILLE REST HOME
Other - Org Name:MELVILLE REST HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:H
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-288-5816
Mailing Address - Street 1:3 MELVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-2105
Mailing Address - Country:US
Mailing Address - Phone:617-288-5816
Mailing Address - Fax:617-288-6372
Practice Address - Street 1:3 MELVILLE AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER CENTER
Practice Address - State:MA
Practice Address - Zip Code:02124-2105
Practice Address - Country:US
Practice Address - Phone:617-288-5816
Practice Address - Fax:617-288-6372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19524311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility