Provider Demographics
NPI:1194703520
Name:EASTPOINTE NURSING HOME INC
Entity type:Organization
Organization Name:EASTPOINTE NURSING HOME INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:CATERINA
Authorized Official - Middle Name:MINA
Authorized Official - Last Name:IMBRIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-251-9001
Mailing Address - Street 1:3 ALLIED DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-6122
Mailing Address - Country:US
Mailing Address - Phone:781-251-9001
Mailing Address - Fax:781-251-9007
Practice Address - Street 1:255 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-3508
Practice Address - Country:US
Practice Address - Phone:617-884-5700
Practice Address - Fax:617-884-7005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0939314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0920541Medicaid
MA225557Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER