Provider Demographics
NPI:1801957246
Name:COREY HILL NURSING HOME, INC.
Entity type:Organization
Organization Name:COREY HILL NURSING HOME, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:H
Authorized Official - Last Name:THISSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-762-0703
Mailing Address - Street 1:80 ACCESS RD
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-5237
Mailing Address - Country:US
Mailing Address - Phone:781-762-0703
Mailing Address - Fax:781-762-2099
Practice Address - Street 1:249 COREY RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-8323
Practice Address - Country:US
Practice Address - Phone:671-734-7138
Practice Address - Fax:671-731-8359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0528314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0999636Medicaid
MA0692880001Medicare NSC
MA225609Medicare Oscar/Certification