Healthcare Provider Details

I. General information

NPI: 1700872967
Provider Name (Legal Business Name): ELLIS NURSING HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 ELLIS AVE
NORWOOD MA
02062-3946
US

IV. Provider business mailing address

135 ELLIS AVE
NORWOOD MA
02062-3946
US

V. Phone/Fax

Practice location:
  • Phone: 781-762-6880
  • Fax: 781-769-7515
Mailing address:
  • Phone: 781-762-6880
  • Fax: 781-769-7515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0793
License Number StateMA

VIII. Authorized Official

Name: MR. NORMAN J SCZEPANSKI JR.
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 508-450-2482