MEDICARE: MARBLEHEAD HEALTHCARE SOLUTIONS LLC

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	251J00000X	Nursing Care Agency
2	314000000X	Skilled Nursing Facility

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	225398	OTHER		MEDICARE PTAN

General Provider Information

NPI Number	:	1568197804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARBLEHEAD HEALTHCARE SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	271 NAHANT RD
Second Line	:
City	:	NAHANT
State	:	MA
Zip	:	01908-1341
Country	:	US
Telephone Number	:	781-581-0420
Fax Number	:

Provider Business Practice Location Address
First Line	:	39 LAFAYETTE ST
Second Line	:
City	:	MARBLEHEAD
State	:	MA
Zip	:	01945-1939
Country	:	US
Telephone Number	:	781-631-6120
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	TARIQ QURESHI
Credential	:
Telephone Number	:	617-504-0294

Provider Enumeration Date	:	07/20/2022
Last Update Date	:	07/20/2022

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