Provider Demographics
NPI:1942391461
Name:BERKSHIRE RETIREMENT HOME, INC.
Entity Type:Organization
Organization Name:BERKSHIRE RETIREMENT HOME, INC.
Other - Org Name:BERKSHIRE PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FORFA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-445-4056
Mailing Address - Street 1:290 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6824
Mailing Address - Country:US
Mailing Address - Phone:413-445-4056
Mailing Address - Fax:413-997-3923
Practice Address - Street 1:290 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6824
Practice Address - Country:US
Practice Address - Phone:413-445-4056
Practice Address - Fax:413-997-3923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0742314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA225762Medicare Oscar/Certification