Provider Demographics
NPI:1336411727
Name:CHELSEA JEWISH GREEN HOUSE
Entity Type:Organization
Organization Name:CHELSEA JEWISH GREEN HOUSE
Other - Org Name:LEONARD FLORENCE CENTER FOR LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
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:617-887-0001
Mailing Address - Street 1:165 CAPTAINS ROW
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-4019
Mailing Address - Country:US
Mailing Address - Phone:617-887-0001
Mailing Address - Fax:617-889-6176
Practice Address - Street 1:165 CAPTAINS ROW
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-4019
Practice Address - Country:US
Practice Address - Phone:617-887-0001
Practice Address - Fax:617-889-6176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA002Q314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0950043Medicaid
MA110024502CMedicaid
MA110024502EMedicaid