MEDICARE: DEUTSCHES ALTENHEIM INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility
2	261QA0600X	Adult Day Care Clinic/Center		MA
3	261QH0700X	Hearing and Speech Clinic/Center
4	261QP2000X	Physical Therapy Clinic/Center
5	261QX0100X	Occupational Medicine Clinic/Center
6	314000000X	Skilled Nursing Facility	0740	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2222554001	OTHER	MA	BLUC CROSS
3	2222554010	OTHER	MA	BLUE CROSS OUT PATIENT
4	903196	OTHER	MA	HARVARD PILGRIM
5	980667	OTHER	MA	TUFTS
6	7100048	OTHER	MA	EVERCARE

General Provider Information

NPI Number	:	1528062387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEUTSCHES ALTENHEIM INC.

Provider Business Mailing Address
First Line	:	2222 CENTRE ST
Second Line	:
City	:	WEST ROXBURY
State	:	MA
Zip	:	02132-4034
Country	:	US
Telephone Number	:	617-325-1230
Fax Number	:	617-323-7523

Provider Business Practice Location Address
First Line	:	2222 CENTRE ST
Second Line	:
City	:	WEST ROXBURY
State	:	MA
Zip	:	02132-4034
Country	:	US
Telephone Number	:	617-325-1230
Fax Number	:	617-323-7523

Authorized Official
Title or Position	:	CEO
Name	:	MR. MICHAEL B LINCOLN
Credential	:
Telephone Number	:	617-325-1230

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	09/04/2019

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