Provider Demographics
NPI:1720074594
Name:JAVER, LLC
Entity Type:Organization
Organization Name:JAVER, LLC
Other - Org Name:PHILLIPS MANOR NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JALIL
Authorized Official - Middle Name:
Authorized Official - Last Name:NASSIRZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-592-8000
Mailing Address - Street 1:28 LINWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01905-1638
Mailing Address - Country:US
Mailing Address - Phone:781-592-8000
Mailing Address - Fax:781-598-1556
Practice Address - Street 1:28 LINWOOD RD
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01905-1638
Practice Address - Country:US
Practice Address - Phone:781-592-8000
Practice Address - Fax:781-598-1556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0332314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0925403Medicaid
MA0925403Medicaid