Provider Demographics
NPI:1942285291
Name:HOME FOR AGED WOMEN, INC.
Entity Type:Organization
Organization Name:HOME FOR AGED WOMEN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE A/R DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERBLOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-879-4050
Mailing Address - Street 1:201 S HUNTINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4888
Mailing Address - Country:US
Mailing Address - Phone:617-522-3080
Mailing Address - Fax:617-524-4746
Practice Address - Street 1:201 S HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-4888
Practice Address - Country:US
Practice Address - Phone:617-522-3080
Practice Address - Fax:617-524-4746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA860314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0999172Medicaid
MA0999172Medicaid