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General NPI Number Information
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NPI Number | 1194714170
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Entity Type | Organization
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Legal Business Name | JESMOND NURSING HOME CORPORATION
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Dates
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Enumeration Date | 10/21/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 271 NAHANT RD
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City | NAHANT
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State | MA
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Zip | 01908-1341
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Country | US
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Telephone | 781-581-0420
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Fax | 781-596-0878
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Provider Business Mailing Address
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Address Line | 271 NAHANT RD
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City | NAHANT
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State | MA
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Zip | 01908-1341
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Country | US
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Telephone | 781-581-0420
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Fax | 781-596-0878
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAURA COSTIN SCALISE
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Credential |
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Telephone | 781-581-0420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 0334
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License Number State | MA
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