Provider Demographics
NPI:1194714170
Name:JESMOND NURSING HOME CORPORATION
Entity type:Organization
Organization Name:JESMOND NURSING HOME CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAURA
Authorized Official - Middle Name:COSTIN
Authorized Official - Last Name:SCALISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-581-0420
Mailing Address - Street 1:271 NAHANT RD
Mailing Address - Street 2:
Mailing Address - City:NAHANT
Mailing Address - State:MA
Mailing Address - Zip Code:01908-1341
Mailing Address - Country:US
Mailing Address - Phone:781-581-0420
Mailing Address - Fax:781-596-0878
Practice Address - Street 1:271 NAHANT RD
Practice Address - Street 2:
Practice Address - City:NAHANT
Practice Address - State:MA
Practice Address - Zip Code:01908-1341
Practice Address - Country:US
Practice Address - Phone:781-581-0420
Practice Address - Fax:781-596-0878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0334314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0928194Medicaid
MA0928194Medicaid