Healthcare Provider Details

I. General information

NPI: 1811983240
Provider Name (Legal Business Name): FALL RIVER JEWISH HOME. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 ROBESON ST
FALL RIVER MA
02720-5496
US

IV. Provider business mailing address

538 ROBESON ST
FALL RIVER MA
02720-5496
US

V. Phone/Fax

Practice location:
  • Phone: 508-679-6172
  • Fax: 508-675-6510
Mailing address:
  • Phone:
  • Fax: 508-675-6510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0634
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0924148
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: MS. CHRISTINE M. VITALE
Title or Position: ADMINISTRATOR
Credential: CNHA , FELLOW
Phone: 508-679-6172