MEDICARE: NORTH SHORE REHABILITATION SERVICES 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	261QH0100X	Health Service Clinic/Center		MA

General Provider Information

NPI Number	:	1801059738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH SHORE REHABILITATION SERVICES LLC

Provider Business Mailing Address
First Line	:	4197 WASHINGTON ST
Second Line	:
City	:	ROSLINDALE
State	:	MA
Zip	:	02131-1733
Country	:	US
Telephone Number	:	617-323-8880
Fax Number	:	617-323-8886

Provider Business Practice Location Address
First Line	:	4197 WASHINGTON ST
Second Line	:
City	:	ROSLINDALE
State	:	MA
Zip	:	02131-1733
Country	:	US
Telephone Number	:	617-323-8880
Fax Number	:	617-323-8886

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. ALEKSEY FLEYSHMAN
Credential	:
Telephone Number	:	617-323-8880

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	10/17/2008

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