Provider Demographics
NPI:1881669273
Name:ERLIN MANOR NURSING HOME INC
Entity Type:Organization
Organization Name:ERLIN MANOR NURSING HOME INC
Other - Org Name:BLAIRE HOUSE OF TEWKSBURY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-948-7383
Mailing Address - Street 1:51 SUMMER STREET
Mailing Address - Street 2:
Mailing Address - City:ROWLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01969-1833
Mailing Address - Country:US
Mailing Address - Phone:978-948-7383
Mailing Address - Fax:978-948-3421
Practice Address - Street 1:10 ERLIN TERRACE
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-2666
Practice Address - Country:US
Practice Address - Phone:978-851-3121
Practice Address - Fax:978-640-0981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0808314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0911631Medicaid
MA0911631Medicaid