MEDICARE: CHELSEA JEWISH NURSING HOME, INC.

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	862	MA
2	314000000X	Skilled Nursing Facility	0559	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891780268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHELSEA JEWISH NURSING HOME, INC.

Provider Business Mailing Address
First Line	:	17 LAFAYETTE AVE
Second Line	:
City	:	CHELSEA
State	:	MA
Zip	:	02150-2010
Country	:	US
Telephone Number	:	617-884-6766
Fax Number	:	617-887-0618

Provider Business Practice Location Address
First Line	:	17 LAFAYETTE AVE
Second Line	:
City	:	CHELSEA
State	:	MA
Zip	:	02150-2010
Country	:	US
Telephone Number	:	617-884-6766
Fax Number	:	617-887-0618

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ADAM S. BERMAN
Credential	:
Telephone Number	:	978-471-5146

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	06/27/2019

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