MEDICARE: BOSTONIAN SNF 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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1164379285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOSTONIAN SNF LLC

Provider Business Mailing Address
First Line	:	350 GRANITE ST STE 2304
Second Line	:
City	:	BRAINTREE
State	:	MA
Zip	:	02184-4963
Country	:	US
Telephone Number	:	781-803-7361
Fax Number	:	781-871-3986

Provider Business Practice Location Address
First Line	:	337 NEPONSET AVE
Second Line	:
City	:	DORCHESTER
State	:	MA
Zip	:	02122-3103
Country	:	US
Telephone Number	:	617-265-2350
Fax Number	:	617-265-0577

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	MR. KEVIN P MORRIS
Credential	:
Telephone Number	:	617-285-7503

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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