1255478962 NPI number — JEWISH REHABILITATION CENTER

Table of content: (NPI 1255478962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255478962 NPI number — JEWISH REHABILITATION CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEWISH REHABILITATION CENTER
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:
6
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:
1255478962
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
240 LYNNFIELD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEABODY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01960-5055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-471-5100
Provider Business Mailing Address Fax Number:
978-471-5508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
240 LYNNFIELD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEABODY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01960-5055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-471-5100
Provider Business Practice Location Address Fax Number:
978-471-5508
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SANTERRE
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
978-471-5100

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 314000000X , with the licence number: 0776 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1948555 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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