Provider Demographics
NPI:1952358392
Name:CHARLWELL HEALTHCARE LLC
Entity Type:Organization
Organization Name:CHARLWELL HEALTHCARE LLC
Other - Org Name:CHARLWELL HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:COPPOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-762-7700
Mailing Address - Street 1:305 WALPOLE ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3021
Mailing Address - Country:US
Mailing Address - Phone:781-762-7700
Mailing Address - Fax:781-255-0387
Practice Address - Street 1:305 WALPOLE ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3021
Practice Address - Country:US
Practice Address - Phone:781-762-7700
Practice Address - Fax:781-255-0387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0774314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110026653BMedicaid
MA0940526Medicaid
MA110026653BMedicaid