Healthcare Provider Details

I. General information

NPI: 1508284076
Provider Name (Legal Business Name): CH-BLUE HILLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 PARK ST
STOUGHTON MA
02072-3762
US

IV. Provider business mailing address

1044 PARK ST
STOUGHTON MA
02072-3762
US

V. Phone/Fax

Practice location:
  • Phone: 781-344-7300
  • Fax: 781-341-2825
Mailing address:
  • Phone: 781-344-7300
  • Fax: 781-341-2825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0592
License Number StateMA

VIII. Authorized Official

Name: ALAN SILVERMAN
Title or Position: DIRECTOR
Credential:
Phone: 561-801-7600