Provider Demographics
NPI:1194432906
Name:BMSH II LCB DEDHAM MA LLC
Entity type:Organization
Organization Name:BMSH II LCB DEDHAM MA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:JACQUES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-619-9327
Mailing Address - Street 1:735 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-4462
Mailing Address - Country:US
Mailing Address - Phone:781-251-9330
Mailing Address - Fax:781-251-9329
Practice Address - Street 1:735 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-4462
Practice Address - Country:US
Practice Address - Phone:781-251-9330
Practice Address - Fax:781-251-9329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility