Provider Demographics
NPI:1528062387
Name:DEUTSCHES ALTENHEIM INC.
Entity type:Organization
Organization Name:DEUTSCHES ALTENHEIM INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:LINCOLN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-325-1230
Mailing Address - Street 1:2222 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-4034
Mailing Address - Country:US
Mailing Address - Phone:617-325-1230
Mailing Address - Fax:617-323-7523
Practice Address - Street 1:2222 CENTRE ST
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-4034
Practice Address - Country:US
Practice Address - Phone:617-325-1230
Practice Address - Fax:617-323-7523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X, 261QH0700X, 261QP2000X, 261QX0100X
MA261QA0600X
MA0740314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0908908Medicaid
MA2222554001OtherBLUC CROSS
MA2222554010OtherBLUE CROSS OUT PATIENT
MA903196OtherHARVARD PILGRIM
MA980667OtherTUFTS
MA7100048OtherEVERCARE
MA0908908Medicaid