Provider Demographics
NPI:1700872967
Name:ELLIS NURSING HOME, INC.
Entity Type:Organization
Organization Name:ELLIS NURSING HOME, INC.
Other - Org Name:ELLIS NURSING & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCZEPANSKI
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:508-450-2482
Mailing Address - Street 1:135 ELLIS AVE
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3946
Mailing Address - Country:US
Mailing Address - Phone:781-762-6880
Mailing Address - Fax:781-769-7515
Practice Address - Street 1:135 ELLIS AVE
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3946
Practice Address - Country:US
Practice Address - Phone:781-762-6880
Practice Address - Fax:781-769-7515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0793314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2222521101OtherBLUE CROSS
MA0908029Medicaid
MA903249OtherHARVARD PILGRIM HEALTH PL
MA903249OtherHARVARD PILGRIM HEALTH PL