Provider Demographics
NPI:1043638463
Name:CH-QUINCY LLC
Entity type:Organization
Organization Name:CH-QUINCY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-801-7600
Mailing Address - Street 1:11 MCGRATH HWY
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5311
Mailing Address - Country:US
Mailing Address - Phone:617-479-2820
Mailing Address - Fax:617-471-5226
Practice Address - Street 1:11 MCGRATH HWY
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5311
Practice Address - Country:US
Practice Address - Phone:617-479-2820
Practice Address - Fax:617-471-5226
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHESTNUT HEALTH AND REHABILITATION, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0432314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA225263Medicare Oscar/Certification