Provider Demographics
NPI:1922087667
Name:NEVILLE COMMUNITIES HOME INC
Entity Type:Organization
Organization Name:NEVILLE COMMUNITIES HOME INC
Other - Org Name:NEVILLE CENTER AT FRESH POND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:KARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-497-0600
Mailing Address - Street 1:640 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1116
Mailing Address - Country:US
Mailing Address - Phone:617-497-0600
Mailing Address - Fax:617-864-0415
Practice Address - Street 1:640 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1116
Practice Address - Country:US
Practice Address - Phone:617-497-0600
Practice Address - Fax:617-864-0415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0680314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0926213Medicaid
MA7100698OtherEVERCARE
MA225378Medicare Oscar/Certification