1386634020 NPI number — ADMIRAL'S HILL ASSISTED LIVING II, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386634020 NPI number — ADMIRAL'S HILL ASSISTED LIVING II, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADMIRAL'S HILL ASSISTED LIVING II, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386634020
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 LAFAYETTE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHELSEA
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02150-2010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-884-6766
Provider Business Mailing Address Fax Number:
617-889-6176

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
175 CAPTAINS ROW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHELSEA
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02150-4079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-889-8740
Provider Business Practice Location Address Fax Number:
617-887-0135
Provider Enumeration Date:
10/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BERMAN
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
617-889-6766

Provider Taxonomy Codes

  • Taxonomy code: 311500000X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1902873 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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