Provider Demographics
NPI:1891780268
Name:CHELSEA JEWISH NURSING HOME, INC.
Entity Type:Organization
Organization Name:CHELSEA JEWISH NURSING HOME, INC.
Other - Org Name:KATZMAN FAMILY CENTER FOR LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-471-5146
Mailing Address - Street 1:17 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-2010
Mailing Address - Country:US
Mailing Address - Phone:617-884-6766
Mailing Address - Fax:617-887-0618
Practice Address - Street 1:17 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-2010
Practice Address - Country:US
Practice Address - Phone:617-884-6766
Practice Address - Fax:617-887-0618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA862314000000X
MA0559314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0901156Medicaid
MA110025683AMedicaid
MA225451Medicare Oscar/Certification